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:______________________________________________






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

Type of Organization: (please check one)

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

____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:_____________________________



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?_________