Charitable Contribution/Sponsorship Form

Charitable Contribution/Sponsorship Form
Request Date

MonthDayYear
Date
Organization*
Contact Name*

First NameLast Name
Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Your relationship to this organization*

EmployeeVolunteerStudentFundraiserOther
Short Description of Your Organization*
How Will Funds or Items be Used?*
What Kind of Advertising/Signage/Recognition will 10:9 Design LLC receive, if any?*
Who do we need to send artwork to, if required.
example@example.com
Are there any other organizations like ours being asked to donate?*

YesNoUnknown
What type of contribution are you requesting?*

Monetary OnlyServices OnlyMonetary and Services
Amount Requested*
Amount not guaranteed. Monetary donation can be UP TO this amount.
To whom should the check be made payable?*
Services Requested*
Be as specific as possible. The more options we have the more able we are to help.
By what date do you need the contribution?*

MonthDayYear
Date
Signature*

Clear
INTERNAL USE ONLY
Thank you for the opportunity to partner with your organization. After an internal review we have a decision as to whether we are able to partner with you at this time. That information can be found below. If your request was denied then we gave specific reasons. Please feel free to resubmit your request based on this information. Please don't hesitate to contact us should you have any questions. Have a blessed day!
Req. #
Date of Review

MonthDayYear
Date
Final Decision
Final Decision Email
Details/Explanations
Should be Empty:

Charitable Contribution/Sponsorship Form

INTERNAL USE ONLY