Fundraising & Donation Request Form,

*** you can fill out this form, print, and either mail it or drop it off at our corporate office at 1821 Spring Arbor Rd. Jackson, MI 49203 attn. SeanKennedy

Polly's Food Service feels that it is important to give back to the community which has been so faithful to us over the years. We are more than willing to help out our community to show our appreciation. We have provided many donations to schools, churches, and non-profit organizations. Once the form is submitted we will look into the process. Please allow us two weeks for a typical response.

Name of Soliciting Agency
Solicitor's Name
Street Name
City
State
Zip
Telephone
Person to call for confirmation of request?

Incorporated as Non-Profit in which state?

Has the IRS granted to you tax deductible status?
	Yes No
What is your relationship to the agency you are soliciting for? Employee, Volunteer, Broker, etc

What percentage of gifts (sales) do you receive?

What is the service nature of your organization?

How will gifts be utilized?

What amount are you seeking from us? If not cash, what other items are you inquiring about?

Provide the name and address of any parent organization your group functions under.

Please enter the date of the event in which you are requesting our support?