1% for Humanity

Primary Contact Name * First Last
Title/Position *
Email address *
Phone Number * ### - ### - ####
How did you first hear of 1% for Humanity?
I would like to join 1% for Humanity with (select one): *
my business as a whole a specific brand within my business entity
If joining w/ specific brand only please list Brand Name here:
Web Site url: *
Effective Date I would like my membership to begin: * MM / DD / YYYY
Legal Name of Business Entity: *
State or territory where your business is registered: *
Type of business entity (corporation, LLC, sole proprietorship, partnership, etc.): *
Fiscal year dates (e.g. Jan. 1 - Dec. 31): *
Principal Business Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
What industry is your business in? *
Please describe the marketing materials, websites and/or products on which you intend to use the 1% for Humanity member logo: *
Please select your expected Annual Revenues (Sales) category for the current fiscal year and your corresponding annual member fee category (USD): *
$0 to $100K = $100 annual fee $100,001 to $500K = $250 annual fee $500,001 to $1M = $500 annual fee $1,000,001 to $10M = $1,000 annual fee $10,000,001 to $50M = $2,500 annual fee $50,000,001 to $100M = $5,000 annual fee >$100,000,000 = $10,000 annual fee
Please write a brief (up to 350 characters) description of your business that may be placed on our website in your company's member listing (subject to approval and/or editing):
Maximum Allowed: 350 characters. Currently Used: 0 characters.
Attach your company/brand logo or other image for use in your member listing (will be cropped to fit within 180 x 67 pixel size) (JPEG file prefferred):
Approved nonprofit(s) you plan to support with your donations:
Is there a nonprofit 501(c)3 public charity (or international equivalent) that is not currently on our list that you would like to suggest for approval? Please limit these requests to organization(s) that you plan to support with your donations and list them here:
other notes you care to share with us:
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