OPERATION ROUND UP APPLICATION FOR DONATION FOR ORGANIZATION/AGENCY

Operation Round Up Application for Donation for Organization/Agency

Operation Round Up Individual app header UPDATED.jpg

OPERATION ROUND UP APPLICATION FOR DONATION FOR ORGANIZATION/AGENCY

Name of Organization

Address

Address continued

City/Town

State/Province

ZIP/Postal Code

Contact Person

Phone Number

Email Address

Dollar Amount Requested

Purpose of Request

Include specifics of how funds will be used.

Other Sources of Funding

List other sources of funding for use of request as described above.

Is organization requesting funding exempt from payment of income tax?

Yes

What area(s) will be served by this request?

If your organization is awarded funding, who should the check be written out to, and what is the address it should be mailed to?

The information contained in this statement is for the purpose of obtaining funding from the Central Wisconsin Electric Trust on behalf of the undersigned. Each undersigned understands that the information provided herein is used in deciding to grant funding, and each undersigned represents and warrants that the information provided is true and correct until a written notice of a change is provided. The Central Wisconsin Electric Trust is authorized to make all inquiries they deem necessary to verify the accuracy of the statements made herein.

Signature of Representative

Sign above

Name of Organization

Date Signed

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OPERATION ROUND UP APPLICATION FOR DONATION FOR ORGANIZATION/AGENCY