Donation Request Form - Luke

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DONATION REQUEST FORM
Name of Organization:
______________________________________________________________________
What does your organization do:
____________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
What are you requesting (be specific):
_______________________________________________________
___________________________________________________________________________________________
How will the requested funds/items be used and who will this impact:
__________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
501(c) 3:
YES
NO *If yes please provide number:
________________________________________
Contact:
___________________________________________________________________________________
Address:
__________________________________________________________________________________
Phone:
:
______________________________ Email
________________________________________________
Please complete and return to:
Donation Requests Attn: HR - Donations
3580 N. Hobart Rd. Hobart, IN 46342
Email to:
donations@lukeoil.com
or Fax to: 219.962.3685
 
Save/Print
Internal use only:
Decision: ________________ Approved by: _________________________ Date: ___________
Amount: ________________ Payment Processed: ____________________ Date: ___________
Company: _____________ Account: _____________ Month: ____________ Class: ___________
Please attach completed form to payment, and return to HR - Donations
 
 
G – DR01
 
 
DONATION REQUEST FORM
Name of Organization:
______________________________________________________________________
What does your organization do:
____________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
What are you requesting (be specific):
_______________________________________________________
___________________________________________________________________________________________
How will the requested funds/items be used and who will this impact:
__________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
501(c) 3:
YES
NO *If yes please provide number:
________________________________________
Contact:
___________________________________________________________________________________
Address:
__________________________________________________________________________________
Phone:
:
______________________________ Email
________________________________________________
Please complete and return to:
Donation Requests Attn: HR - Donations
3580 N. Hobart Rd. Hobart, IN 46342
Email to:
donations@lukeoil.com
or Fax to: 219.962.3685
 
Save/Print
Internal use only:
Decision: ________________ Approved by: _________________________ Date: ___________
Amount: ________________ Payment Processed: ____________________ Date: ___________
Company: _____________ Account: _____________ Month: ____________ Class: ___________
Please attach completed form to payment, and return to HR - Donations
 
 
G – DR01

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