APPLICATION FOR DONATION FOR ORGANIZATION/AGENCY

APPLICATION FOR DONATION FOR ORGANIZATION/AGENCY

APPLICATION FOR DONATION FOR ORGANIZATION/AGENCY

AGENCY INFORMATION

Address

Street or P.O. Box
City
State
Zip Code

Phone Number

Work
Home
Other (specify

Contact Person:

Name
Title
Email address
Is organization requesting funding exempt from payment of income tax:
If yes, a copy of letter (Form 501[c]3) from Internal Revenue Service MUST be uploaded.
A copy of financial statement(s) for most previous year MUST be provided.
Maximum upload size: 33.55MB
Does agency serve outside counties listed above?

REQUEST

REFERENCES

Please list three references (References may not be given by a director or employee of Coweta-Fayette Electric Membership Corporation or Coweta-Fayette Trust.)

The information contained in this statement is for the purpose of obtaining funding from the Coweta-Fayette Trust on behalf of the undersigned. Each
undersigned understands that the information provided herein is used in deciding to grant funding, and each undersigned represents and warrants that the
information provided is true and complete and that the Coweta-Fayette Trust may consider this statement as continuing to be true and correct until a written notice of a change is provided. The Coweta-Fayette Trust is authorized to make all inquiries they deem necessary to verify the accuracy of the statements
made herein.

Name of Organization
Signature of Representative
Date

IMPORTANT APPLICATION INFORMATION: Operation Round Up Trust board meets in January, March, May, July, September and November. Applications must be received at Coweta-Fayette EMC by the 20th day of the month before the meeting. Example: June 20 is the deadline for the July meeting, etc. Please follow instructions on the application carefully and include ALL information requested. NOTIFICATION: You will be notified by mail of the Board’s decision on the request

Maximum upload size: 33.55MB