Request An Account

Please fill out this form to request an account for the Booster Juice Fundraising website.

All fields are required unless otherwise indicated.

Organization Information

Organization Type Please indicate which type of organization you are requesting an account for.

Organization Name

Confirm Email

Address Line 1

Address Line 2

City

Province

Postal Code

Country

Phone Number

Phone Number Extension (optional)

Fax Number (optional)

Your Information

First Name

Last Name

Confirm Email

Phone Number

Phone Number Extension (optional)

Please enter a username and password. This login will be used to access the fundraising website once your application is approved.

User Name

Password

Confirm Password

Additional Information

Tell us about yourself and what you are fundraising for.

Are you a not for profit (non-profit) organization?

If yes, please explain how you are a non-profit organization. (optional)

What is your registered charitable number? (optional) You can search for your charitable number by clicking here.

What is the best time to reach you?