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Bustard Chrysler Waterloo Donation Request Form
Name of Organization
If applicable, tax registration or official designation number:
Organization Range (Local, Regional, or National)
Type of Organization
Arts and Entertainment
Children & Families in Crisis
Name of Contact Person
Title in Organization of Contact Person
Phone Number of Contact Person
Email of Contact Person
Amount of Funds Requested
Type of Relationship to us (e.g. purchased car, service, employee)
Have you received funding from us before?
Yes, three or more times
Will this be a one time donation or recurring payment?
If the donation will be used/related to a event please specify what event it is for
What date does the donation need to be received by?
What will the donation be used for? (in 100 words or less)
How will we know the money has been used effectively? (in 200 words or less)
How do you plan to acknowledge the dealership? (in 100 words or less)
What sets your organization apart from similar organizations? (in 150 words or less)
Please give examples of how you have used donation money in the past effectively?
Please list any organizations who have donated to your organization in the past with a contact name, phone number, and email to be used as a reference. (preferred 3)
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