Request Form for Material or Monetary Donations and Sponsorships

PLEASE NOTE: Please allow up to three weeks to evaluate any donation requests

CONTACT INFORMATION
Organization Name
Address
City:	State ZIP:
Contact Person
Job Title
Phone Number
Email Address

Is this your first request for donation to Chaney Enterprises? If yes, and is a monetary request, please provide a copy of your W-9 tax form with this request (Contact info supplied on next page). If no, please list date of donation and what the purpose of the donation was:

BACKGROUND INFORMATION
1. What programs and/or services does your organization provide?
2. What areas does your organization provide service?
3. Approximately how many people will take advantage of services offered?
4. How would Chaney Enterprises’ contribution be acknowledged at your event?
5. Is this a monetary or material donation request? (select one) Monetary Material

MONETARY DONATION REQUEST - REQUIRED INFORMATION
1. Please list the monetary amount your organization is currently requesting:
2. What will the donation be used for?
3.When will the donation be needed by?

MATERIAL DONATION REQUEST - REQUIRED INFORMATION
1. Please specify the material and quantity of material that you are requesting: Estimate the amount needed here
2. Please provide the physical address of where the delivery will be made?
Address
City:	State ZIP:
3. For what will the donation be used?
4. When will the donation be needed?