Contact Name * Campaign Role * Keyworker Campaign Manager Contact Phone * Contact Email Agency Name * # of Personnel Campaign Kickoff Date if known Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Please allow ten business days for supplies delivery. CC order to Delivery Contact Name * Delivery Contact Email * Delivery Contact Phone * Delivery Address Line 1 * Delivery Address Line 2 Delivery Address Line 3 Delivery City Delivery State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Delivery Zip Code * Is there a loading dock * Yes No Special Instruction for delivery Security Contact Name if required Security Instructions/Requirements Charity Listing (ordering ration 1:25, 1 per every 25 employees) Pledge Form Reporting Envelope for submitting paper pledge forms Campaign Manager Guide Keyworker Guide/Checklist Barometer Poster 11 x 17 Poster C - Veterans (ordering ratio 1:100, 1 per every 100 employees) 11 x 17 Poster B - Woman and Dog 11 x 17 Poster A -Sailor Tent Card - Military/Civilian Tent Card - Military/USPS Donor Card - Tips for Giving Thank you Card