JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
UW2021 Limited Items/ Reservation
Reservation form for raffle tickets, commemorative beer, and Pizza 44 event.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your Name
Your answer
What division are you with?
Hickok & Boardman Insurance
Coldwell Banker Hickok & Boardman
Hickok & Boardman HR Intelligence & Retirement Solutions
Hickok & Boardman Capital Management
Clear selection
PRE-ORDER H&B Commemorative Beer: Please indicate how many four packs @ $20 you'd like to reserve. Beer must be picked up at the wrap up event at HULA. Cash please. ALL of the money raised goes towards the campaign.
Choose
1 - 4 pack = $20
2 - 4 packs = $40
3 - 4 packs = $60
4 - 4 packs = $80
Solo Stove Fire Pit Raffle has CLOSED, HOWEVER, You can still buy a package of 5 fortune cookies for $5 OR buy an insulated tumbler or water bottle with 200th/United Way logo for $25 WHILE SUPPLIES LAST. How many would you like?
Solo Stove Bonfire (Stand Included)
Choose
5 Cookies = $5
5 Gluten Free Cookies = $5
Travel Mug = $25
Water Bottle = $25
Will you be paying by:
Cash/check (see your UW contact to make payment. Checks to: United Way of Northwest VT)
Credit card (bill me at end of UW week)
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
