Name *

First Name

Last Name

Phone *

(###)

###

####

Contact's Phone Number *

(###)

###

####

Has the charity ever operated under a different name?

Yes

No

Does the organization have 2 years of 990 tax returns available for review?

Yes

No

Will any portion of the POWER of 100+ donation go towards administrative fees?

Yes

No

If the charity is selected to receive our quarterly donation, would someone from the organization be available to speak at the next meeting to describe the impact of the donated funds?

Yes

No

Does the organization agree to provide charitable tax receipts to our members?

Yes

No

Does the organization agree NOT to sell, give or use our members' contact information for solicitations by themselves or other organizations?

Yes

No