Coupon Book Request

Organization name *

I agree to use these coupons only for fundraising of my non-profit organization. *

Contact name *

Contact driver's license number *

Home number *

Area Code Phone Number

Work number

Area Code Phone Number

E-mail *

Organization address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Shipping address if different

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Fundraiser start date *

Number of coupon books requested

Comments / Questions

Now therefore, in consideration of the mutual promises contained herein, it is agreed as follows:

Rutter’s will permit the Organization to sell coupon books for participating Rutter’s locations as part of a fundraising project for the Organization.

Within 60 days of receipt of the coupons ordered, the Organization agrees to reimburse Rutter’s $5.00 per coupon book.

Payment for sold coupons and any unsold coupons should be sent directly to Rutter’s at this address:

Attn: Fundraising

2295 Susquehanna Trail, Suite C,

York, PA 17404

The undersigned, individually and on behalf of the Organization, agrees to be held responsible for the number of coupon books ordered above and received from Rutter’s for deli sandwiches and hereby agrees further to be individually liable for the payment of all sold coupons, the return of any and all unsold coupons, plus fees and payment for lost or stolen coupons within 60 days of the agreement date stated above.

If coupons are lost or stolen, the Organization will reimburse Rutter’s $5.00 per coupon book. Whether or not the loss is due to any negligence on the part of the Organization.

The Organization agrees to indemnify and hold harmless Rutter’s in connection with any liability incurred as a result of the sale or distribution of the coupons for deli sandwiches as referred to herein.

Signature

Clear

**Office Use Only**