Membership Checkout - SimplePay Rewards

Membership Information

You have selected the Fundraiser Account membership level.

The price for membership is $0.00 now.

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Account Information

Username

Password

Confirm Password

Email Address

Confirm Email Address

Full Name LEAVE THIS BLANK

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More Information

First Name

Last Name

Phone

Please format your number like (123) 456-7890.

W9 Form

A W9 form is only required for Affiliates or Fundraisers. If you intend to register as an Affiliate or Fundraiser, you can provide the form now or after registering by viewing My Account, selecting Account Profile, then selecting Edit Profile and upload it then. A completed W9 form is required before payments can be made over $600 for the calendar year. Download an IRS form W9 here.

Fundraiser Information

Organization Name

Organization Type

Organization is a Non-profit?

Yes

Organization Email

Can be same as contact email, if applicable.

Organization Phone

Please format your number like (123) 456-7890. Can be same as contact phone, if applicable.

Best Way To Reach You

Organization Zipcode

Please enter a 5 digits zipcode.

Organization Website URL

Not required now.You can update your profile after setup. Please format your URL like this: http://www.organizationsite.com (use https if applicable)

Organization Mission Statement

Not required now.You can update your profile after setup. A short, impactful statement outlining the core purpose of the organization.

Organization Problem Statement

Not required now.You can update your profile after setup. A brief explanation of the social issue or need that the organization addresses.

Organization Program Highlights

Not required now.You can update your profile after setup. A concise description of the key programs or initiatives offered by the organization.

Organization Impact Summary

Not required now.You can update your profile after setup. If applicable, quantifiable data showcasing the positive impact of the organization's work.

Organization Address

Not required now.You can update your profile after setup. The full fundraiser organization's address for the fundraiser page.

Organization Logo

Not required now.You can update your profile after setup. Accepted file types: jpg, jpeg, gif, png. Max. file size: 1024 KB

Organization Page Image 1

Not required now.You can update your profile after setup. An image file that you would like included on your fundraiser page.

Organization Page Image 2

Not required now.You can update your profile after setup. An additional image file that you would like included on your fundraiser page.

Billing Address

First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Country

Phone

Payment Information

Card Number

Expiration Date

CVV

Discount Code

I agree to the Terms of Use

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