OSB Donation Request - Formstack

Orlando Solar Bears Donation Request

Organization Name*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Email*

Phone*

Fax

Tax Exempt # / 501c3*

Tax Exempt Documentation*

No File Chosen

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Flyer Documentation*

No File Chosen

File uploads may not work on some mobile devices.

Contact Name*

First Name

Last Name

Contact Phone*

Event Name*

Event Date*

Event Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Event Description*

Item to be used for*

Door Prize Incentive Live Auction Silent Auction Raffle Other

Signature*

I hereby certify that a) the information provided in this request and the supporting documents are correct to the best of my knowledge and b) that the Internal Revenue Service 501(c)3 determination has not been modified, revoked, cancelled or allowed to expire and c) donations will be used for the project/purpose outlined in the application and agreed to by both parties and d) I agree to the guidelines specified on www.orlandosolarbearshockey.com

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