* Email:___________________________________ * Best time to contact:_____________________
Address:_________________________________________________________________________
City:_____________________________________________ State:__________ Zip:____________
* Organization:____________________________________________________________________
* Non-profit corporation number:___________________________ Date incorporated:____________
* IRS tax deduction number:_______________________ Fed tax ID:_________________________
* Your relationship to the organization:__________________________________________________
* Your request:____________________________________________________________________
_________________________________________________________________________________
________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
* Date of event soliciting for:________________________ * Location:_________________________
________________________________________________________________________________
* Additional information attached: Yes________ No________
* Signature:_______________________________________________________________________
* Date:_____________________________ * Best contact number:___________________________