1 Organization Information2 Donation Details3 Signature Organization Name*Does your organization have a 501(c)3 status?*YesNoContact Person*Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*What is your website?Are you a current Blackfoot customer?YesNo Donation DetailsNext, tell us a bit more about your donation request.What is the purpose of your request?*Event Date(s) and Time*Event Location*What is the donation amount requested?*What is the deadline for sponsorship commitment?*Who should the check be made payable to?*How will the donation be used?*Has Blackfoot sponsored this event before?*YesNoPlease describe who directly benefits from the donation requested.Will this donation be matched with other funds or sponsors (what level)? Blackfoot reserves the right to deny any request or honor a partial amount of the request without stating any reasons. Electronic Signature*Please fill in your name below to electronically sign your application. By doing so, you are acknowledging that you are a representative of the organization, and all information entered on the form is accurate to the best of your knowledge.Date* Upload Proof of Non-Profit Status*You indicated your organization is a non-profit. Please upload documentation that provides proof of your 501(c)3 status.Upload Your W-9If funding is approved, a completed Request for Taxpayer Identification Number and Certification (IRS Form W-9) will be required. You can upload and submit your W-9 now to expedite your request. If you need the W-9 form, please visit http://www.irs.gov/pub/irs-pdf/fw9.pdf. PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.