Oil Can Henry's - Company - Donation Request

Donation Request

*Organization Name
*Address
*City
*State
*Zip Code
*Contact Person
*Job Title
*Email
*Phone
*Fax
*Tax Exempt # (Please provide a copy of your government exemption certificate with this form)
What programs and/or services does your organization provide?
Please describe the event/reason for request (additional information can be attached or faxed).
*Has Oil Can Henry’s contributed to this organization/event in the past?	Yes No
*If yes, what did Oil Can Henry’s contribute?
Please list items your organization is currently requesting:
*What is the deadline for donating?
*Required information

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