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CharityWorks, Inc.	Charitable Alliance Network (CAN) Survey
Confidential CAN Survey on Products and Services Consumed & Registration Request
Organization Name
Address
City
State
Zip
Telephone
Fax
Website
Name of Person Completing Survey
Title of Person Completing Survey
E-Mail
► Funding Sources. Organizations key funding sources include: Federal government State and/or Local government Foundations/other grant makers General donations/contributions Revenue from billable services Other	► Number of Locations. Organization controls and operates number of locations and/or facilities. If more than one location, attach a list of each facilities' key contact name, title, address and phone number. ► Number of Employees & Volunteers. At last count, organization has approx. employees (Count the total number of employees on payroll not just full-time equivalent employees). Organization's volunteer program includes approx. people.
► Procurement Strategies. Organization DOES DOES NOT participate in purchasing/affinity programs. If so, name each provider: 1. 2. 3.	► Purchasing Card. Organization uses credit cards to pay for purchases. Yes No. If no, is organization considering using credit cards? Yes No. Comments:
► Vendor Contracts. Organization has direct access to the following government purchasing contracts: General Services Administration (GSA) State Commodity Contracts County Government City Government No Access to Government Contracts	► Internet Purchasing. Does organization purchase goods and/or services over the Internet? Yes No . If no, is organization considering purchasing goods and/or services over the Internet? Yes No. Comments:
► Budget. Organization's annual capital and operating budgets for the current year are as follows: Capital $ Operating Budget (less payroll and benefits) $
Confidential CAN Survey on Products and Services Consumed & Registration Request ► Types of Products and Services Consumed. Organization purchases the following:
Capital Equipment and Consumables Apparel/Uniforms Appliances, kitchen Audio Visual Equipment Cleaning Equipment Copiers Computers and Accessories Computer Software Construction and Building Materials Floor Covering Foods Furniture (all types) Household Goods and Supplies Janitorial Products and Cleaning Chemicals Laboratory and Medical Products Laundry Products and Chemicals Lawn and Garden Equipment Medical Equipment Musical Instruments Office Supplies Paper and Paper Goods	Pharmaceuticals Publications Toiletries Tools Trophies, Awards and Promotional Materials Signs Vehicles Services Auditing, utilities Financial Banking Consulting Employment Food Insurance Printing/Publishing Purchasing Card Telecommunications
Mr. Chris R. Renfrow, President/CEO CharityWorks, Inc. 915 Chestnut Street Clearwater, FL 33756-5643 Please register our organization in CharityWorks' Charitable Alliance Network (CAN) program. We understand the annual registration fee is $100, there are no purchasing requirements, and we can withdraw from this program at any time. If you have any questions regarding this form or the registration process, please e-mail here.
Date
Name of Nonprofit Officer
Title of Nonprofit Officer

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Charity Works, Inc. 635 Court Street - Suite 130, Clearwater, FL 33756-5512

Phone: (727) 447-2064 - Toll Free: (877) 728-3294 - Fax: (727) 447-1892

Charity Works, Inc., provides nonprofits with a single point ordering solution to receive maximum savings when purchasing selected nationally recognized product lines and services. Florida Services Cooperative is the official CharityWorks® Network online merchant account and nonprofit fundraising assistance system.


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