CHARITABLE DONATION REQUEST FORM

Organization must first meet the following requirements to be considered eligible:

The organization must qualify as a registered 501(c)3 nonprofit organization by the U.S. IRS
The request is not for a political or religious purpose.

Organization information:

Name:

Email Address:

Address:

City:

State:

Zip:

Phone No:

About the organization:

Tax Id#

Mission:

Geographical Area Served:

Organization’s website:

Programs and Activities:

Request:

Where funds will specifically be used for, and the expected benefits.

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