Corporate Donation Request

Corporate Donation Request

Applicant Information

Address
Address
City
State/Province
Zip/Postal
Name of Contact Person
Name of Contact Person
First
Last

Tax Information

Is your organization an IRS 501(c)(3) non-profit?
Maximum upload size: 157.29MB

Donation Request Information

Which ALCIVIA Corporate Donation Category are you applying under?

Acknowledgement

I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that false information may disqualify my organization from receiving a donation.