Contribution Request

Thank you for your interest in the Green Auto Group.  Please fill out the form below and fax it along with any other relative information to 309-691-1209.  We request 90 days advance notice on all donation/contribution requests.

* Indicates Required Information

* First Name:_______________________________ * Last Name:________________________________

* Email:___________________________________ * Best time to contact:________________________

Address:_______________________________________________________________________________

City:_____________________________________ State:_____________  Zip:_____________________

* Organization:_________________________________________________________________________

* Non-profit corporation number:_____________________________ Date incorporated:____________

* IRS tax deduction number:________________________  Fed tax ID:___________________________

* Your relationship to the organization:____________________________________________________

* Your request:_________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

* Date of event soliciting for:__________________________ * Location:_________________________

______________________________________________________________________________________

* Additional information attached:  Yes________  No________


* Signature:____________________________________________________________________________

* Date:________________________________ * Best contact number:___________________________