Organization Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Name *

First Name

Last Name

Contact Phone *

(###)

###

####

When do you plan to start selling tickets? *

Do not plan on a starting date less than two weeks from the submission of this form.

MM

DD

YYYY

I understand our organization will be selling individual car wash tickets redeemable at any NuWay Car Wash location in Plattsburgh, NY. *

Yes