Quapaw Casino Community Partnership Donation Request Form Required Information:

1. All Donation Requests Forms must be complete and concise and contain the following information: a. Full name of organization b. Telephone number c. Fax number and email (if applicable) d. Complete mailing address e. Website address (if applicable) f. Name and title of contact person g. Deadline for receiving your donation

h. State or local affiliations

i. Non-profit or tax identification number and a copy of the exemption letter issued by the Internal Revenue Service classifying the entity as a 501(c3) organization. j. Fully completed and signed W-9 U.S. tax form (refer to https://www.irs.gov/ for the most updated form) k.A brief summary of the organization, including a clear description of its purpose or mission, those who benefit from it, and the geographic area in which it operates. I. Details of the event or program, including its date, purpose, expected attendance and beneficiaries m. Specific donation request (ex. donation amount or items to be auctioned) n. Names of any QCA/QC Team Members, who are employed by, provide goods and services to, or volunteer for the organization o. Overall organization objectives p. Details of how QCA/QC and other donors will be recognized

2. The Donation Request Form must be submitted with this form, by email (QC.marketing@quapawcasino.com), fax (918-540-0784), or mail to the Executive Office at Quapaw Casino at least 60 days before the donation deadline.