Donation Or Advertising Request Form

DONATION OR ADVERTISING REQUEST FORM

TO BE FILLED IN BY THE CUSTOMER

PLEASE ALLOW TWO WEEKS FOR PROCESSING

Customer Name:

Customer Address:

City: State: Zip Code:

Daytime Phone:

Organization Benefiting:

Organization Address:

City: State: Zip Code:

Daytime Phone:

Tax Exempt Number: Tax Id Number:

DONATION REQUEST

Explain the purpose for the donation, how it benefits the community and the amount or merchandise requested:

ADVERTISING REQUEST

What Is The Publication? Print Date:

Size And Price Specifications:

(Attach If Necessary)

Internal Use Only

Marketing Director Approval: Date:

President Approval: Date:

Board Approval: Date:

Send All Donation Requests to Melanie Kauffman

or

Union Bank, 933 Fourth Avenue, Lake Odessa, MI 48849