Donation Request Form - Schmolck Mechanical Contractors printable pdf download

Donation Request Form - Schmolck Mechanical Contractors

Donation Request Form

Organization: _______________________________________________________________

Contact Name: _______________________________ Title: __________________________

Phone Number: ______________________________ E-Mail: ________________________

Mailing Address: ____________________________________________________________

City: __________________________________ State: ______ Zip Code: _______________

Donation Type:

O Monetary Donation/Sponsorship: Amount $___________________

O In-Kind Donation: Item (s) Requested ________________________

Date donation is needed: _______________________________________________________

Please describe the purpose of the donation (event, auction, etc): _______________________

Has SMC provided a donation for your organization in the past? O yes

O No

If yes, what items and when? ______________________________________________

Additional information or comments: ______________________________________________

The above information is correct to the best of my knowledge. Shall the donation be approved,

I will use the donated goods for the purpose listed above

__________________________________________________

______________________

Signature

Date

__________________________________________________

______________________

Print Name

Title (relationship to org.)

For internal use________________________________________________________________

__ Approved __ Rejected

Approved By ____________________________

Date _______________

Picked up by: ____________________________

Date _______________

110 Jarvis St.

949 Stedman St.

Sitka, AK 99835

P.O. Box 8756

P:(907) 747-3142 / F:(907) 747-6897

Ketchikan, AK 99901

P(907) 225-6648 / F(907) 225-0374

schmolck@ak.net

Donation Request Form - Schmolck Mechanical Contractors