Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. – Step 1 of 2Name *FirstLastTitle *Organization *Email *Phone *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code Organization Payment Preference Proof of Non-Profit Status Drag & Drop Files, Choose Files to Upload You can upload up to 3 files. Please upload a document showing your nonprofit status, such as an IRS 501(c)(3) letter, Illinois nonprofit certificate, recent IRS Form 990, or a letter of good standing.Accounts Payable Contact *FirstLastPayment Preference *— Select Choice —Submit a checkPay onlineCustom Captcha *What is 2+2? NextSubmit Application
