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:
 Yes No

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?:
 Yes No

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:

Signature of Contact Person: