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Name:
First: Last:

School Name:

Which organizations are you involved in?
Please list all that apply. ie- Soccer, Band, Spanish Club etc.
Organization 1
Organization 2
Organization 3
Organization 4
Organization 5


Which organizations have you ordered apparel for through Midwest Impressions?
Please list all that apply.
Organization 1
Organization 2
Organization 3
Organization 4
Organization 5

Have you visited our website before today?

Yes
No

What did you like about Midwest Impressions that made you want to order from us?

Is there anything about the ordering process you'd like us to change?

Is there anyone else in your school that orders apparel for their organization that we should send a catalog to?
Your name will be added into the drawing for each valid contact and e-mail address!

Name: Organization: Email Address:
Name: Organization: Email Address:
Name: Organization: Email Address:
Name: Organization: Email Address:
Name: Organization: Email Address:

Midwest Impressions will NOT share your information with any third party.