Charity Cost Program Application Acknowledgements By filling out this form, I understand that I am requesting participation for my organization in Scheller's Fitness & Cycling CHARITY COST PURCHASE PROGRAM. I understand that this is NOT a request for a donation or sponsorship. I understand that participation in this program offers discounts up to 30% off the retail prices. This discount is available to charitable organizations for their events and auctions. Only applications meeting the above criteria will be considered. I have read the above statement Yes I understand that in order for Schellers' to waive sales tax, I must supply a tax exempt certificate. Yes Date Today's Date (MM/DD/YYYY) Date of the Event (MM/DD/YYYY) Must be received at least 90 days prior to the event. Organization Information Is the Organization a Non-Profit? Yes No Organization Name Organization Address City, State, Zip Code Organization Phone (xxx-xxx-xxxx) Email address Website Address Contact name and title Contact Phone (xxx-xxx-xxxx) Contact Email Address Donation Details What is the event? What merchandise would you like to purchase with the Charity Discount Program? Please note, gift cards are not eligible for this program. How will the merchandise be used? Certification I certify that the merchandise being purchased is for the exclusive use and/or benefit of the Organization referenced in this application and that any merchandise purchased under this program is not being directly consumed our used by myself or another individual. I have read the above statement Yes Thank You! Be sure to click the Submit Form button below so that we receive your application. Keep this field blank