Donation Request

Phone Number*

Name of Organization*

Main Contact (Name of person completing this form)*

Email*

Cell phone*

Street Address*

City*

State*

Zip/Postal*

Country*

Type of Request*

Event

Name of Event*

Date

Location Address

Street Address*

City*

State*

Zip/Postal*

Country*

Description*

Contribution Requested*

Sponsorship

Address

Street Address*

City*

State*

Zip/Postal*

Country*

Description*

Amount Requested*

Auction Item

Date*

Organization Website*

Donation Item Requested*

Donation

Description*

Donation Item Requested*

Other

Description*

Amount Requested*

How will this contribution help?*

Will Lucas Oil Center be recognized?*

Yes

No

If Yes, explain how

Has Lucas Oil Center previously supported this request/organization in past years?*

Yes

No

If so, please explain

Referral*

Supporting Information

Recipient Name

Recipient Organization

Recipient Phone

Recipient Email

Is this a 501(c)3 Charitable request?

Yes

No

Tax ID#*

W9 Upload

Date of Need

Minimum of 2 weeks notice is required for review

How will this be fulfilled?

Will Call Pick Up

Shipping

Which location?

Lucas Oil Center Eastside

Lucas Oil Center Westside

Shipping Name

Address

Street Address*

City*

State*

Zip/Postal*

Country*

Shipping Phone

Attachment upload for supporting documentation

DONATION REQUESTS

DONATION REQUESTS

– DISCLAIMER –

Event

Location Address

Sponsorship

Address

Auction Item

Donation

Other

Supporting Information

Address

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