Sponsorship Form Page

Please fill your information below.

You are sponsoring

• Clean Green Main Street
• DIY Clean Up Stations
• Annual Planter
• Others

Please Specify the program you are sponsoring. *

Name *

First

Last

Company ( If any )

Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Email *

Phone *

Any messages

I agree to the following charge *

• 25 USD
• 50 USD
• 100 USD
• 250 USD
• Other Amount

Please enter your donation amount

Minimum Price: $1.00

I agree to the following charge *

• 1 Planter - $450.00
• 2 Planters - $900.00
• 3 Planters - $1,350.00

Total

$0.00

PayPal Commerce *

PayPal CheckoutCredit Card

Card Number

Expiration Date

Security Code

Card Holder Name

Submit