Charitable Giving Program

Business Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Point of Contact Name *

First Name

Last Name

Point of Contact Phone Number *

(###)

###

####

Is your organization a registered 501(c)3? *

If the answer is “no”, your organization does not qualify for this program.

Yes

No

Event/Program Date (if applicable)

MM

DD

YYYY

If your request is approved, are you willing to provide Neighborhood Establishment with final event/program information such as brief synopsis on how the event went, participation numbers, pictures, etc. as requested? *

Yes

No

By submitting your application, you hereby certify that the facts set forth in the above donation request application are true and complete to the best of your knowledge. You also acknowledge that this application is no guarantee of funding and that all requests are at the sole discretion of Neighborhood Establishment. *

I understand and agree