Josh Freeman -
www.joshfreeman.org
Wholesale Application - 50% off Retail Prices
Shown
Telephone +1-508-802-5012
Print this form and fax it completed to
+1-508-824-3052, or email to
josh@joshfreeman.org
You can also mail this to: Josh Freeman,
P.O. Box 652, Raynham Center, MA 02768, USA
(For use by individuals and organizations both
profit and non-profit)
Contact Person
_______________________________________________________________________
Citizen of
____________________________________________________________________________
Business Name
_______________________________________________________________________
Address
____________________________________________________________________________
City
_______________________State
_______
Zip ____________
Country
____________________
Phone
_________________________
E-Mail
______________________________________________
Website
___________________________________________________________________________
Type of
Organization
__________________________________________________________________
Affiliate or
Parent
Organization
__________________________________________________________
Number of
Members
_________________________________________________________________
Main Interest
_______________________________________________________________________
State/Province
or Country Tax
Number (attach
photocopy)
____________________________________
Signature
_____________________________________
Date
_______________________________
Title
______________________________________________________________________________
Print this form
and fax it
completed to
+1-508-824-3052,
or email to
josh@joshfreeman.org
Or mail to:
Josh Freeman,
P.O. Box 652,
Raynham Center,
MA 02768, USA
For Office use
only
Approval sent
with
email/letter
____________
Tax exempt cert.
on file
_______________
Computer
upgraded
_______________ |
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