Sponsorship Form Page Please fill your information below. Please enable JavaScript in your browser to complete this form. 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
