Donation Request Form

Donation Application

As a member-owned Cooperative, CTC encourages active support of the community we serve by providing sponsorships and donations to tax-exempt, non-profit organizations and community groups. Please fill out the form completely and submit. A downloadable PDF version of the form is also available on our website.

Name of Organization/Event(s)

ex. Cordova School District

Name

First NameLast Name

Contact Email

example@example.com

Contact Phone Number

Area CodePhone Number

Address to Mail Check if Approved

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Application

Date

Date of Event(s)

Date

Deadline for Response

Date

Type of Event

Type of Request (choose one)

If cash, enter amount requested.

Amount Requested

If goods/service, please identify.

Type of Goods/Services Requested

Is this an annual or one-time request?

Brief description of the organization or event and its benefit to the community.

Tell us who you are and what you do.

If granted, how will the contribution be used?

ex. Travel to state competition, Purchase t-shirts for event promotion, etc.

Are you a 501(c)(3) or (c)(6) organization?

If NO to above, give tax classification.

Tax classification

How will CTC/CWC be recognized for their donation/sponsorship?

ex. Name printed on t-shirts, newspaper "thank you," etc.

Name of Board of Directors or Key Members of the Organization.

ex. John Smith, Jane Doe, etc

Are you a customer? Select all that apply.

Donation Requested From:

How many years has CTC/CWC contributed to your organization/event and what have we contributed?

ex. Cash donation, door prize items, etc

If you'd like to be added to our e-mail list, enter your preferred e-mail address here.

FOR INTERNAL USE ONLY

APPROVED ( ) YES ( ) NO

BY:_______________________

Send Where and When______________________________________

Request Filled By:___________________

Date:_________________

Items:___________________________________________________

________________________________________________________