Fred Hill Materials – Donation Request Form P. O. Box 6, Poulsbo, WA 98370 ▪ Phone: (360) 779-4431 ▪ Fax: (360) 779-5509 ▪ Toll Free: 800-422-5010 Type or print clearly. Please allow 6-8 weeks for processing.
CONTACT PERSON			EMAIL
ORGANIZATION NAME			DOLLAR AMOUNT (OR ITEMS) REQUESTED:
ADDRESS
CITY	STATE	ZIP	MAKE CHECK PAYABLE TO:
WORK PHONE ( )	HOME PHONE ( )		FAX ( )
Benefiting Organization
ORGANIZATION TO BENEFIT FROM FUNDRAISER			TAX STATUS ____ Exempt: Tax ID #____________________ ____ Non-Exempt: indicate reason:
PURPOSE OF ORGANIZATION
			ORGANIZATION STATUS: ____Public ____Private
DONATION WILL BENEFIT:
INDICATE SPECIFIC PROGRAMS TO RECEIVE FUNDS (Use Back of Form if More Space Needed)
Fundraising Event
EVENT NAME (if applicable)			TYPE OF EVENT ___ Raffle ___ Auction ___ Other ________________
LOCATION CITY & STATE			DATE (a specific date must be provided. e.g. drawing date for raffle)
MARKETING / PROMOTION PLAN
Additional Information
HAS A FRED HILL MATERIALS EMPLOYEE REFERRED THIS REQUEST OR BEEN INVOLVED WITH YOUR ORGANIZATION AS A CONTRIBUTOR, VOLUNTEER, OR DIRECTOR? _____Yes _____No IF YES, NAME OF EMPLOYEE
HAS YOUR ORGANIZATION REQUESTED A DONATION FROM FRED HILL MATERIALS BEFORE? _____Yes _____No IF YES, WHEN WAS THE LAST REQUEST MADE?
COMMENTS:

Signature: _____________________________________________________________________________________________ Date: _____________________________

(For Office Use Only)

Approved by:_____________________________________ Amount:____________________________ Date:__________________