Donation/Sponsorship Request Form

Today's Date:

Organization Name:

Name of Contact Person:

Contact Mailing Address:

City:

State:

Zipcode:

Contact Phone Number(s):

Contact Email Address:

Is This Organization a 501 (c) (3) non-profit:
YesNo

Organization Website (if any):

Please describe what type of donation you are seeking and how that support will be used:

If this donation is for an event, what type of event is it?:

Date of Event:

Estimated number of attendees at event:

How are you advertising your event:

If you are requesting monetary assistance, how much money are you requesting? (in $USD):

If this request is for in-kind goods or services (i.e. items for an auction or fundraiser), what kind of specific gifts or services are you requesting?:

If double kwik awards your organization a donation, but you do not reach your fundraising goal, what will happen to the support/donation that we give you?:

Please describe what other efforts you are undertaking to reach your fundraising goal:

If double kwik honors this request, or a portion of it, and makes a donation, how will our name, logo, and identity be visible to the community?:

Has double kwik contributed to this organization/event in the past?:
YesNo

If yes, when and what was the donation?

If there is any additional information about your organization or event that you believe further supports your request, please attach that printed information to this application. Please note: A completed application is NOT an agreement to honor your request. It should also NOT be implied that the request will or would be funded in its entirety. By submitting this application with your signature below as the contact person for the organization making the request acknowledges that you have read and agree to the donation criteria attached to this application form.

Signature of Contact Person: