Donation Request Form - Us Cellular Center
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1DONATION REQUEST FORM
PLEASE PRINT
Requests should be submitted at least 4-6 weeks in advance of an event to allow time for review.
Tickets will be issued; we do not authorize monetary donations.
Due to the large number of requests, U.S. Cellular Center is unable to guarantee a response to all
donation requests. If approved, the donation will be mailed. No phone calls please.
Today’s Date:______________________
ORGANIZATION INFORMATION
____________________________________
___________________
_________________
Name of Organization
EIN/Tax ID#
501(c)3 Status
___________________________________________
__________________
___________
_________
Mailing Address
City
State
Zip
_________________________
____________________________
_______________________________
Phone
Organization Website
Contact Email Address
_______________________________
_________________________________
________________________
Name of Contact
Title or Relationship to Organization
Contact Phone(if different)
EVENT INFORMATION
________________________________________
___________________________________________
Event Name
Date, Time and Place of Event
_________________________________________________________________________________________________
Purpose of the Event
_________________________________________________________________________________________________
How will money raised be used?
_________________________________________________________________________________________________
How will the US Cellular Center tickets be used?
____________________________________
____________________________
_____________________
Area/Community the event will serve?
Expected Number of Attendance
Request Deadline
In what ways will USCC be recognized?_________________________________________________________________
Mail this completed form:
Email:
U.S. Cellular Center
Attn: Donation Committee
370 1st Avenue NE
Cedar Rapids, Iowa 52402
FOR U.S. CELLULAR CENTER USE ONLY
_____________________
Date Received
Donation___________________
Notes_______________________
Status_____________________________
GS#_______________________
____________________________
Authorized By_______________________
Delivered___________________
____________________________
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Parent category: Business