Donation Request

Name of event/project*
Date of event or project

MonthDayYear
Type of request

Financial SupportItem/ProductService
Name of Organization*
Address (Street or PO Box)*
City*
State*
Zip Code*
Contact Information
Full Name*
Title*
Phone Number*
Format: (000) 000-0000.
Email*
Description of the event/project*
If applicable, please attach available brochures, program descriptions, flyers, etc.

Cancelof
Has Cunningham Telephone & Cable supported this event/project in the past?

YesNo
Make checks (if applicable) payable to:
Date donation needed

MonthDayYear
Tax deductible?

YesNo
Please send a receipt to the following address:
Cunningham Telephone & Cable, Attn: Alica Wildfong, P.O Box 108, 220 W Main, Glen Elder, KS 67446
*
Should be Empty:

Contact Information