Organization Name Organization Logo Organization Website, Facebook, etc. 501c3 or 501c6 Tax ID Number (required for all donations) Procurement for upload “Choose File” OR Do you have a Procurement Form? Description of Organization/Mission Contact's First Name Contact's Last Name Email Address Mailing Address City State Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Contact Number Please explain what type of donations you are requesting. How will this donation be used? Event Name Event Date Event Information Is this request for a Benevolent Night? Yes No If yes, how do you plan to enhance the Benevolent Night event?nevolent Night? How will the funds from your Benevolent Night be used? Additional Information Send
