Coop To Coop Request Form
This is an application for a Cabot Creamery Cooperative gift box under Cabot's Co-op to Co-op Program.
Date of Request: 08 / 21 / 2008		Date of Event: mm/dd/yyyy
Have you received a Cabot Creamery Cooperative gift box in the past? No Yes *
* If you have received a contribution from us in the past, please be advised we have a 2-year maximum for consecutive contributions		* please specify years and amounts
Name of Co-op:
* First Name:		* Last Name:
Title:
* Shipping Address:
(we cannot ship to a PO Box)
* City:
* State:		-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY * ZIP:
* Phone:		* Email:
Fax:		Website:
Tax-exempt #:
About the Event/Organization
Event Name:
What is the focus of the work of your cooperative?
Please provide information about your co-op's event
Projected Attendance
Who is your target audience?
How will you use our contribution to support your co-op?
Do you have the means to keep the gift box refrigerated at 34F - 40F?
How will Cabot be mentioned in the program, signage, advertising, etc?
Additional Comments:
All fields must be completed in order for your application to be considered. Thank you.