BBCS – donation Intake Form – Mid-Michigan Industries

Date of Request *

Date of Event *

Contact Name *

First

Last

Organization Name *

Address *

Organization of Organization

City State Zip

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email Address *

Phone Number *

Type of Organization

Service Club
Religious Organization
501 (c) 3 Non-Profit
Other (describe)

Type of Event *

Purpose of the Event (describe how funds raised will be used) *

Other Information

*Bankers Brew is a social enterprise that contributes 100% of its profits to support people with disabilities in Central Michigan. For this reason, we can only honor limited requests.

*Donations are not provided for individuals, or to support fundraisers for individuals.

*Requests must be received at least 30 days prior to your event. If your request can be supported, notification will be made by email no later than 2 weeks before the event.

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