Donation or Sponsorship Request Form

Name of the organization

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone number

Web site / URL

Please describe the project.

Please provide the following information and add any other relevant financial details.

Amount requested from the Caisse Alliance

Total cost of the project

*For requests over $10,000, please check with the other funds offered by Caisse Alliance.

Amount already raised from other sources

Have you requested funds from another Caisse Alliance branch?

Please describe the type of visibility you plan to offer the Caisse. For example, display the Caisse Alliance logo on a sign.

Name *

Email address *

Telephone number