Part 2- Matching Gift Form- Charitable Organization

Part 2- Charitable Organization Matching Gift Form
Employer Identification Number (EIN)
Organization Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Website Address, if any
Date Gift Received

Month Day Year
Date
Amount of Gift to be Matched
Authorized Officer's Name

First Name Last Name
Title
How would you like to receive your Matching Gift?

Check Electronic ACH
If you selected "Electronic ACH", please complete the information below:
Bank Account Number
Routing Number
I hereby certify that this organization/program meets the eligibility requirements of the Crystal Equation Matching Gift Program, and that neither the donor nor Crystal Equation will derive any personal material benefit from this gift or match.
Signature

Clear
Thank you for all that you do! Upon verification that the matching gift request meets Crystal Equation Matching Gift guidelines, we will process the matching gift. If guidelines are met, please allow 30-60 days to receive the Matching Gift in the form of a check to the organization and address listed above. If you have any questions, please e-mail hr@crystalequation.com.

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Part 2- Charitable Organization Matching Gift Form