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Community Service Request Form
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Request Date
*
Funding Date
*
Requested Amount:
*
Organization Name:
*
Organization Tax ID:
*
Address, City, State, Zip:
Contact Name:
*
First
Last
Contact Phone:
*
Email
*
Website URL:
*
Facebook URL:
*
Please Describe Organization's Mission:
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Please describe the Fundraiser Event and how the proceeds will be utiized:
Notification Selection
We would appreciate it if you would take a photo of our donation at your event and send it to us for use on our Social Media platforms. It will help to promote your organization and it's worthy causes.
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