Fish Tale Ale Brewpub Mural, Olympia

Fish Tale Ale Brewpub Mural, Olympia.

Contribution Request Form

Organization Contact

Submitted By

Organization Name First Name
Address Last Name
City Email
State    
Zip    

Organization Information

Primary Purpose of Organization 
Are you or your organization a customer of Olympia Federal Savings?   Yes  No
Is the organization a private, non-profit organization?   Yes  No
Has it received Internal Revenue Service designation?   Yes  No
Tax-exempt IRS number (required for OFS support)    (Attach a copy of your IRS designation letter.) [action TBD]

Description of program/project for which funds are requested

Total fund drive  $ 
Amount secured to date  $ 
% from private donations  $ 
% from government grants  $ 
Amount requested of Olympia Federal Savings   $ 
Is this a  local   statewide   nationwide  drive?
Do you receive, or will you request support from United Way?   Yes  No
If yes, what is the reason for the current request?

Additional Organization Information

Please check the category of your organization/project
United Way/Federated Drive
Health & Welfare, Human Services
Education
Civic & Community Needs
Culture & the Arts
Other (please specify) 
Have you contacted any other Olympia Federal Savings office for Support?    Yes  No
If yes, list office name, location and contact name
Describe Olympia Federal Employee involvement in your organization (such as volunteers, board members, etc.)
Geographic area served
Name/address of firm performing annual audit
List the names and affiliations of directors and officers of your organization
List the other corporate contributors and their giving levels

Attach your most recent financial statement (preferably audited) and your current annual budget including income and expenses. [action TBD]
To whom should the check be made payable?