Contribution For:
Benefactor's Federal Tax ID:
Community that will benefit:
Donation Deadline:
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February 2012
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Full Name:
Mailing Address:
City:
State:
Zip:
Country:
(Select One)
USA
Other
Phone Number:
Email Address:
Kimball Employee:
(Select One)
Yes
No
Giving Category
(Select One)
Education (pre-school, elementary, high school and university levels)
Health & Human Services
Civic & Community Programs
Arts & Culture
Religious Institutions (non-denominational, all inclusive)
Other
Reason for Request:
(Select One)
Certified 501(c)3 Organization Fundraiser (American Cancer Society, etc)
School Fundraiser (non-sports related)
Community Fundraiser
Local Civic Fundraiser
Sports Fundraiser & Benefit
Religious Institution Capital Campaign, Building/Renovation Project
Personal Fundraiser & Benefit
Other
Reason Comments:
Requested Amount