Contributions Request

Kocourek Group Outreach… Dedicated to giving back to the community. Kocourek Automotive Group believes it is important to individually address each contribution request.   However, because of the literally hundreds of requests that we receive Kocourek Automotive Group has established the following required contribution request form.

 Download a printable version of this form here.

                                         DONATION REQUEST FORM

 

Completion of this form is a request only and does not guarantee a donationIn order to be considered, donation requests must be received a minimum of 6-8 weeks prior to the event. Only approved request will be notified.

 

Organization Name:______________________________________________

 

Address:_______________________________________________________

 

County:_____________City:____________________State:______Zip:_____

 

Telephone: (___) _____-_____          Fax: (____) ______-______


Type of Organization: (please check one)

____Animal Welfare     ____Church        ____Arts & Culture             ____Civic & Community _____Government/Military 

____Athletic 
____Education   _____Business ______Health & Human Services  ____Environment/Agriculture

 

Tax Exempt#/501c3 (attach documentation)__________________

 

Contact Name:___________________ Contact Telephone (______) _____-______

 

Event Date:_____________  Event Name:_________________________________

 

Event Location:______________________________________________________

 

Description of Event:__________________________________________________

 

Item to be used for: (Please check one)

 

Door Price:________   Incentive:________ Silent Auction:_______   Raffle:_____

Live Auction:_______  Other:________________

 

Donation Shipping Address:_____________________________

Attention:___________________________________________

Address:____________________________________________

City, State, Zip_______________________________________

                                             

We give back because we can, because we care and because we believe that everyone doing a little can accomplish a lot.  Enhancing the lives of those around us is both a responsibility and a privilege.

 

Has your organization made a request in the last 12 months?_________

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