Affiliate Intake Form - Dolly Parton's Imagination Library

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Country

Partner Organization

This is the organization that will be listed on the DPIL website to receive inquiries about the local program.

Organization Name(Required)

Organization Description

A bio for the organization

Logo File

Recommended dimensions: 250px x 160px

Accepted file types: png, jpg, Max. file size: 2 MB.

Logo Info

Facebook Page Link

Instagram Page Link

Twitter Page Link

Allow Donations(Required)

Would you like to allow visitors to imaginationlibrary.com to make donations designated to your program?

Yes

Donation Email Notification

What email address should receive a notification when a donation is designated?

Donation Email Notification CC

Another email address that should receive the same notification (Optional)

Coverage Area

Please provide ONE of the coverage areas you will serve. You will be able to add others once you receive access to the BOS (book order system).

Post Code(Required)

State(Required)

City(Required)

County(Required)

Coverage Area

Please provide ONE of the coverage areas you will serve. You will be able to add others once you receive access to the BOS (book order system).

Post Code(Required)

Town(Required)

Coverage Area

Please provide ONE of the coverage areas you will serve. You will be able to add others once you receive access to the BOS (book order system).

Street Address(Required)

Registration Information

Registration Options

Please select the registration options you wish to offer for the coverage area provided.

Online

Mail-In

On Location

Mail-in Registration Information

(Required if accepting mail-in registration forms)

Registration Mail-in Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Registration Mail-in Address(Required)

Street Address Address Line 2 City State

Zip Code

County

On Location Registration Information

(Required if allowing walk-in registrations)

On-Location Address Options

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Sameas Mailin

sameas-mailin

On Location Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

On Location Address(Required)

Street Address Address Line 2 City State

Zip Code

County

Book Label Information

The partner organization that will appear on the book label. (Required; Must be 501c3 in USA)

Book Label Organization Name(Required)

Book Label Contact Name

First Last

Book Label Address Options

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Sameas Mailin

sameas-mailin

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Sameas Onlocation

sameas-onlocation

Book Label Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Book Label Physical Address(Required)

Street Address Address Line 2 City State

Zip Code

County

USPS Mailing Approval

If you have already received documentation, please upload your nonprofit mailing approval authorization form from the USPS. (Documents must be distributed by or signed/stamped by the USPS.) You can upload this into the BOS at a later time if you have not yet received from the USPS.

Max. file size: 150 MB.

Primary Contact

The person who signed the MOA

Primary Contact Name(Required)

First Last

Contact Email Address(Required)

Primary Contact Phone Number(Required)

Program Contact Information

This information will be displayed on the affiliate profile on imaginationlibrary.com and is the public contact for the local partner’s DPIL program

Program Contact Options

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Same As Primary

program_sameas_primary

Program Contact Name(Required)

First Last

Program Contact Email Address(Required)

Program Contact Phone Number(Required)

BOS Main Coordinator Information

This person will manage the affiliate information and registrations in the BOS (book order system) with the highest level of user access; this may be the Program Contact or another representative from the partner organization depending on the needs of your organization. Information provided is to set up a user account and is not public faci

BOS Main Coordinator Options

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Same As Primary

maincoord_sameas_primary

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Same As Program

maincoord_sameas_program

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Existing Group Information

Group Coordinator Email(Required)

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Group Coordinator ID

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New Coordinator Information

Main Coordinator Contact Name(Required)

First Last

Main Coordinator Contact Email Address(Required)

Main Coordinator Contact Phone Number(Required)

Main Coordinator Address Options

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Sameas Mailin

sameas-mailin

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Sameas Onlocation

sameas-onlocation

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Sameas BookLabel

sameas-booklabel

Main Coordinator Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Main Coordinator Mailing Address(Required)

Street Address Address Line 2 City State

Zip Code

County

Billing Organization

Information for Organization who will be invoiced for books

Billing Organization Options

Billing Organization Name(Required)

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New Billing Organization Information

Billing Contact Information

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Same As Primary

billing_sameas_primary

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Same As Program

billing_sameas_program

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Same As MainCoord

billing_sameas_maincoord

Billing Organization Contact(Required)

First Last

Billing Organization Contact Email(Required)

Billing Additional Recipients

If you wish for other contacts to receive copies of invoices, please enter their email addresses.

Preferred Payment Method

Billing to be Originated By

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Admin & Dynamic Fields

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Regional Director

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Regional Director Email Address

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Copper Identifier

The Copper entry ID that this should connect to

Phone

This field is for validation purposes and should be left unchanged.