New Image Day & Med Spa Donation Request Form

1. Contact Information

Name of Organization/Individual Requesting Donation:*

Contact Person (If Different):

Email Address: *

Phone Number:*

Website or Social Media Link (if applicable):

2. Type of Donation Request

What type of donation are you requesting?*

Financial DonationGift Cards or Certificates (e.g., for auctions, raffles, or giveaways)Product/Service Donation (e.g., skincare products, treatments)Event Sponsorship (e.g., providing funds, products, or services for an event)Volunteer/Staff InvolvementOther

3. Details of the Cause or Event

What is the name of your event or cause?*

Please provide a brief description of the cause/event and its goals.*

What is the date and location of the event (if applicable)?

Date

Location:

4. Target Audience

Who will benefit from this cause or event? (Please provide demographic details, such as age, location, and number of people affected or expected to attend.)*

How does this event or cause align with our values and community focus (healthcare, education, social justice, etc.)?*

5. Specific Donation Request

How much funding or what type of in-kind donation are you requesting?*

How will the donated funds/products/services be used?*

What exposure or recognition will New Image Day & Med Spa receive in return for our donation? (E.g., logos on promotional materials, mention in social media posts, recognition at the event.)*

6. Impact and Reporting

How will the success of the cause/event be measured? (Please describe how the funds or donation will have an impact, and how you plan to measure success.)*

Will you provide any follow-up reports or updates on the results of the donation?

YesNo

(If yes, please describe how you will report back to us.)

7. Additional Information

Is there anything else you would like us to know about your cause or event?*

8. Supporting Documents

Please attach any relevant documents or promotional materials that can help us understand your cause better (e.g., brochures, flyers, tax-exempt status, event programs, etc.).

Document 1:

Document 2:

Document 3:

9. Acknowledgement and Agreement

By submitting this request, I agree to the following:

That the information provided is accurate to the best of my knowledge.
That New Image Day & Med Spa has the right to evaluate this request and may choose not to donate based on their community involvement strategy or resource availability.
That any donation given will be used as described and acknowledged as per our agreed terms.

Signature

Date

10. Acknowledgement and Receipt Requirement

Receipt for Donation:
In order to maintain accurate records for tax purposes, we require that all recipients of donations from New Image Day & Med Spa provide an official receipt or confirmation letter that acknowledges the donation. The receipt should include the following:

Date of Donation
Description of the Donation (including type and quantity if applicable)
Estimated Value of the Donation (for in-kind donations or services)
Contact Information of the Receiving Organization.

Will your organization provide a receipt upon receiving the donation?

YesNo

If yes, please provide the contact information or the person responsible for issuing the receipt.
Name
Title
Email
Phone Number