Register Round-Up Application

If your organization is interested, please complete this form by Thursday, May 31, 2018.

Valley Natural Foods’ Round-Up Program allows customers to round-up their grocery bill to benefit organizations that share our values. A calendar of rotating monthly recipients is established annually. One organization is selected per month and all donations made that month will go to the designated recipient. Recipients also receive donations through our Green Stamp Program. Through this program shoppers can choose to donate 5¢ for every reusable bag they use.

Register Round-Up Application

Organization*
Website*
Contact Name*
First Last
Organization's Mailing Address*
Street Address Address Line 2 City State ZIP Code
Name and address for check remittance*
- Same as above.
- Different as above.
Contact Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Is your organization a food shelf?*
- Yes
- No
Is your organization a 501(c)(3) nonprofit?*
- Yes (Please include certification below with submission)
- No
501(c)(3) Certification
Preferred Recipient Month
We will try our best to accommodate requests, however it is not guaranteed.
Tell us about your organization and mission.*
How do you plan to use round-up funds?*
Our cashiers usually have 10 seconds or less to describe the monthly round-up recipient to customers. In two sentences or less describe your organization and how the funds will be used.*

Register Round-Up Application

If your organization is interested, please complete this form by Thursday, May 31, 2018.

Register Round-Up Application

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