Co-Brand Request Form

This form will bring you one step closer to having your own We-Care co-branded affiliate mall!
Please fill out fields completely and accurately. We will send out an email confirmation if your request is approved.
If you have any questions, please feel free to Contact us.

---

Contact Info:
Contact First Name:
Contact Last Name:
Contact Phone Number:
Contact Email Address:
Organization Info:
Organization Name:
Desired Subdomain:	?
Organization Type:	-- Choose Type -- Arts/Culture Pre K-12 School College/University Educational House of Worship/Religious/Spiritual Environmental Animal Protection/Welfare Public Health/Medical Research Social Service Public Safety Sports/Recreation Humanitarian/Disaster Relief Human Rights/Civil Rights Community Improvement Public Policy Peace and Justice Other
Address Line1:
Address Line2:
City:
State:	-- Choose State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming Puerto Rico American Samoa Federated States of Micronesia Guam Marshall Islands Palau U.S. Virgin Islands Commonwealth of the Northern Mariana Islands AA- Military Post Office AE- Military Post Office AP- Military Post Office
Zip:
Tax Id#:
Request Info:
I am a supporter who wishes to donate to this entity. I am a representative of this entity that can act as an agent on its behalf. (No Fraud!)    and I have read and agreed to the Terms and Conditions.

---

We-Care.com reserves the right to grant, withhold, or revoke access or affiliation to any of our subdomains at any time.
You must adhere to our strict policy protecting the legitimacy of charities. Anyone reserving a legitimate charity's name as a subdomain without actual consent/approval from that charity will be banished from We-Care.com immediately, and considered in violation of our terms of service agreement therefore forfeiting rights to any charitable income earned through our site.