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Distribution Partner Application
Scott
2023-02-13T08:50:23-05:00
Distribution Partner Application
BREADCOIN
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)
*
enter 10 digits
Organization Street Address
*
Organization City
*
Organization State
*
use 2 letter code (e.g. FL, PA, MD, DC)
Organization Zip
*
Organization Website
Leave blank if none
Neighborhood where you expect to distribute Breadcoins
*
Briefly describe the purpose of your organization
*
How and to whom do you expect to distribute Breadcoins?
*
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 Distribution Partner Terms of Agreement.
I agree
Distribution Partner Terms of Agreement
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