DONATION APPLICATION

Name of Organization

Your Name

Tax ID# or 501 (c)(3) if applicable

Date of Application

ORGANIZATION CONTACT INFORMATION

Contact Person

Email Address

Street Address

Apt.#

Daytime Phone Number

Fax Phone Number

City

State

Zip Code

Website

Organization's Mission Statement or Description of Purpose:

Donation Request: (Describe what you are asking for?)

History/Background Informaiton:

Year Founded: 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 Before 1950	City/Geographic area your organization serves:
Estimated number of consumers/people you serve annually:
Other sources of income/financial funding:
Planned date of event(s):
Repeate Event: Date Held:

Description of Programs/Services:

Purpose/Goals/Plans for this donation request:

How will you promote/publicize this event to your members and the public?

If you have any further questions please feel free to call, write or stop by: Barmuda MMC, 6027 University Ave. Suite 100, Cedar Falls IA, 50613 Marketing Department (319)-266-9994 Fax: 319-266-9944, cares@barmuda.com