Charitable Donation Request Form
Subject of Approval by the SEBA Board of Directors
Member name
*
First Name
Last Name
Employee ID #
*
Personal Email
*
example@example.com
Name of Organization You Want to Donate To?
*
Tax ID Number
*
501(c)3?
*
Yes
No
Amount Requested?
*
Point of Contact at Organization?
*
Organization email and/or phone number
*
Purpose of Donation?
*
Make Check Payable To:
*
Mail Check To:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Member Signature
*
Supporting Documentation
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