Cooperatives Involvement in the Community

As a cooperative owned and led by local community members, giving back is a fundamental priority for us. We sincerely appreciate you taking the time to complete the application, and we look forward to the opportunity to support your causes! Please complete the information in the form below or download and print this form to submit as directed on it.

Donations and Sponsorship Form

Requesting Organization:

Name of Contact Person:

Is this a charitable 501(c)3 Organization?

Yes No

Mailing Address:

City:

State:

Zip Code:

Email:

Phone:

Describe your project or event and state the goals/purpose:

Date of event or publication:

Is this event:

One-Time Annual

Indicate amount and type of product, service or funding requested:

(Cash, gift certificates, merchandise, ad sponsor, etc)

If a financial request, please indicate who check should be payable to:

How will this donation be used:

Date Donation or Sponsorship is Needed By:

How will sponsors be recognized:

Is a logo or ad needed?:

Indicate preferred format type and email address to send it to. Ad size if applicable

Additional Details:

Security Code