Community Partner Application

Organization Name *

Organization Federal EIN *

Type of Organization *

School

Church

Nonprofit

Local Government

Hospital

Sports Team

Corporation

Religious Organization

Community Group

Other

First Name (primary contact) *

Last Name (primary contact) *

Primary Contact Title/Role? *

Email Address (primary contact) *

Phone Number (primary contact) *

Organization Street Address *

Organization City *

Organization State *

Organization Zip *

Organization Website

How will your organization be involved in the Breadcoin Economy? *

Purchase Breadcoins for Mobile Food Events

Recurring Purchase Matching Program (Nonprofits can be eligible up to $300/mo.)

Electronic Purchase Meal Program (Nonprofits can be eligible for up to $125 per meal)

Flash Table Program

Emergency Relief Program

Distribution Partner Program

Which Breadcoin team member encouraged you to participate, if any? *

Is there anything else that you would like us to know or a question you would like to ask?

Click to agree to the Breadcoin Community Partnership Agreement.

I agree

Community Partner Form