This form contains three parts: Contact Information, Charitable Request Information, and About Your Organization. Please fill out this form completely, then click on the "Validate Form" button at the bottom of the form. If the form is filled out completely, you will get a message saying you can now submit the request. We will respond to your request as soon as possible. Thank you.
Part 1: Contact Information:
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| Organization Name: |
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| Primary Contact: |  |
| First Name: |
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| Last Name: |
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| E-Mail Address: |
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| Title (Position): |
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Phone Number:
(123) 1234567 | (
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Fax Number:
(optional) | (
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Mailing Address: | | | |
| Address Line 1: |
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Address Line 2:
(optional) |
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| City: |
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| State: |
| Zip Code: |
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Part 2: Charitable Request Information:
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Briefly describe the activity or project for which you are requesting a contribution:
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| Amount you are requesting from Wabash National: | $
| Date donation is needed by:
[mm/dd/yyyy] |
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| What is your targeted fund-raising goal? | $
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| Will you be receiving funding from any other sources? |
| If yes, who?
(If more than one, place a comma between the names) |
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| What is the number of people who will be impacted by this funding? |
| What is the specific timeline for the project? |
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| Is there an event associated with this fund-raiser? |
| If yes, what percentage of total revenues from this event will go to the organization? |
% |
| What is the date of the event? |
| What is the time of the event? |
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| What is the location of the event? |
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| What area will this funding impact (i.e. city/county)? |
| Do you have a budget for this project? |
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| Who will benefit from the project? |
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If Wabash National supports your project, how will you measure its effectiveness and follow up with us regarding your results?
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| Part 3: About Your Organization |
| Does your organization have a budget? |
| Are there any volunteer opportunities within your organization? |
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| If yes, please explain: |
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| For each $100 donated to your organization, how much will go towards: |
Programs: |
% | Fund-raising: |
% |
Future Resources: |
% | Administrative: |
% |
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| Please give a brief background/history of your organization. (Board or parent organization, mission statement, etc.) |
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| Briefly describe your organization's financial accountability: |
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| Please list ways that Wabash National may be recognized for contributing to your organization: |
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Are there any potential non-monetary support
opportunities associated with this request? |
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Please Note: Only forms with the required fields filled out will be considered for funding.
Please click on the "Validate Form" button before submitting the form.
If you experience any problems submitting the form, e-mail us at communityservice@wabashnational.com.
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