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New Organization Info 

& Sales Deck Request

(schools, businesses, sport groups, etc.)

Use this form to provide CharityRx with pertinent Organization information and to request a customized Sales Deck for them.

*The customized Sales Deck would be for pitching the prescription discount program to a new Organization.

Organization Info
& Sales Deck Request Form

REQUESTING PERSON INFO:

ORGANIZATION INFO:

Organization's Address: 

Attach the Organizations logo here. Please try to attach a large, high quality version of the logo. 

Upload Logo (Version 1)
Upload Logo (Version 2)

ORGANIZATION CONTACT PERSON:

SALES DECK INFO:

Would you like to customize the sales deck with the organization's name, logo, and colors?
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