CONTACT INFORMATION
* Indicates required field
*First Name ________________________________ *Last Name _______________________________
*Email ____________________________________
Address _________________________________________________________
City _____________________________________ State ____________ Zip Code _____________
*Incorporated as a non-profit entity? Yes ______________ No _______________
*Non-profit corporation number: _________________________________________________
*Has the IRS granted tax deduction status for your organization? Yes _________________ No _________________
*What is your Federal Corporation Tax ID number? ________________________________________
*Solicitor's Name _______________________________________________________________
*State your relationship to the organization you are soliciting for? __________________________________
*Is your organization registered with the Better Business Bureau? Yes __________ No ___________
*What services are rendered by your organization?___________________________________________________
*What contributions are you seeking from us?__________________________________________________________
*Have you or your organization ever purchased a vehicle from us? Yes ___________ No ___________
*If yes, under what name(s)?_____________________________________________________________
*In what year(s)? ___________________________________________________________
*Solicitor's Signature _________________________________________________________
Date ________________________________________________________________
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