Wisconsin Donor Entry Donor Name First Last Business Name Donor Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Donor Phone*Donor Phone 2Quantities & Pickup DateNumber of DecalsPlease enter a number from 1 to 250.Number of CardsPlease enter a number from 1 to 250.Number of BadgesPlease enter a number from 1 to 250.Number of ShieldsPlease enter a number from 1 to 250.Associate Member ID Pickup Date MM slash DD slash YYYY Pickup Time - From : Hours Minutes AM PM Pickup Time - To : Hours Minutes AM PM Ad InformationAd SizeFront Inside CoverBack CoverBack Inside CoverFull PageTwo Page SpreadHalf Page (vertical)Half Page (horizontal)Quarter PageOther (please specify below)No AdAd Size - OtherPlease provide as detailed an explanation as possible.Will you be providing a logo or other artwork? Yes No Upload your Logo & Artwork Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB, Max. files: 5. Max 5 files allowed. Maximum File Size 512MBDonation Amount and NotesTotal Donation AmountPickup Instructions / NotesSales InformationSalesman Courier Application Mail Dropoff Credit Card
