Online Application

Organization:
Address:
City:
Zip:
State:
Phone:
Email:
Contact Title:

What is your organization's idea or goal to make good things happen?

Approximately how much money will be required to accomplish your organization's Do Good idea or goal?
Is your organization not-for-profit?
Yes      No
Is your organization a 501C3?
Yes      No
Would you like to have a “Fun-Raiser” for 50 or more people at a Chicken Out Rotisserie?
Yes      No
Would you like to sell “Do Good” Cards and receive 30% of the profits?
Yes      No
Would you like to us to Cater an event for your non-profit organization and receive a 15% discount?
Yes      No
Name:  
Position:
Birth Date:
Gender: Male   Female
- I would like to receive the Chicken Out E-Newsletter, Information and promotions from Chicken Out, and Free Coupons
Thank you for doing good.