Request date:

Deadline for response from OTIS FCU:

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Organization's name:

Organization's phone:

If yes, please specify most recent year, dollar amount, and/or additional donation item/volunteer services provided by OTIS FCU:

If other, please specify:

How many in your organization?

How many participating?

If local, please specify the name of the community:

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If yes, in what way?

If requesting advertising, please describe:

If requesting a check, please specify amount:

Check donation should be payable to:

If requesting auction item, raffle prize, or other merchandise, please describe:

If requesting other, please describe:

For what purposes would the donation be used?

Additional comments:

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