Matching Gifts Charity Form

SECTION 1: CHARITY INFORMATION

*Denotes Required Field

Organization Name (as listed on 501(c)(3) determination letter or equivalent):*
Federal Tax ID #:*
Contact Name:*
Contact Title:*
Phone Number:*
email Address:
Mailing Address:*
City:*
State:*
Zip Code:*

SECTION 2: MEMBER(S) INFORMATION

Up to 5 member donations may be entered in one submission.

First Name:*
Middle Initial:
Last Name:*
Suffix:
Mailing Address:*
City:*
State
Zip Code:*
Phone Number:*
email Address:
Date of Gift:*
Amount of Donation:*
 

First Name:
Middle Initial:
Last Name:
Suffix:
Mailing Address:
City:
State:
Zip Code:
Phone Number:
email Address:
Date of Gift:
Amount of Donation:
 

First Name:
Middle Initial:
Last Name:
Suffix:
Mailing Address:
City:
State:
Zip Code:
Phone Number:
email Address:
Date of Gift:
Amount of Donation:
 

First Name:
Middle Initial:
Last Name:
Suffix:
Mailing Address:
City:
State:
Zip Code:
Phone Number:
email Address:
Date of Gift:
Amount of Donation:
 

First Name:
Middle Initial:
Last Name:
Suffix:
Mailing Address:
City:
State:
Zip Code:
Phone Number:
email Address:
Date of Gift:
Amount of Donation:
 

By submitting this form, I confirm the above gift was received and this organization is tax exempt under section 501(c)(3) of the U.S. Internal Revenue Code. I further confirm that no direct, tangible benefit will accrue to the donor, to any member of their family, nor to any related third party as a result of this gift and it will be used to support the charitable objectives of the organization.
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Thank you for your submission! Your request will be reviewed by our Marketing Department.

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