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Contact Information

Organization Registered 501(c)(3) Name*

Organization Doing Business As (DBA) Name*

This will be the name used on the website to identify your organization. This must be entered even if it is identical to the field above. Please double check spelling and capitalization. Do not use all capital letters.

Contact First Name*

Contact Last Name*

Contact Email*

Contact Phone*

Registered Organization Address*

Street Address Address Line 2 City State Zip Code

Organization Information

Number of social followers*

Number of email contacts*

Facebook Page URL

Instagram Page URL

Organization Website*

Organization Mission Statement/Description*

Organization Logo Upload

Accepted file types: jpg, gif, png, pdf, eps, ai, bmp, Max. file size: 128 MB.

Deposit/Banking Information

Organization Tax ID Number*

Name on Bank Account*

Name of Bank*

Account Number*

Routing Number*

Acount Type*

Checking

Savings

Upload IRS W9 Form*

Accepted file types: jpg, png, pdf, txt, doc, docx, Max. file size: 128 MB.

Signature*

Players Philanthropy Fund DBA Tix For Good is hereby authorized to ACH a payment to the account listed above. This authorization will remain in effect until modified or canceled in writing. Type Full Name.

Date*

Deposit/Banking Information

Our organization agrees to Allow Amplifier Fundraising/Tix For Good to use our logo and likeness to promote fundraising sweepstakes on our behalf.*

I agree.

Our organization agrees to help promote these sweepstakes to their supporters through email/social media/live events.*

I agree.

How did you hear about us?

Amplifier Agrees to submit 72% of all proceeds at the conclusion of each sweepstakes.

Contact Information

Organization Information

Deposit/Banking Information

Deposit/Banking Information

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