Donation Request Form

Please fill out the information below and fax or mail at least 2 weeks in advance of your event date. Due to overwhelming requests please refrain from calling to check on a donation status. When approved, the requesting organization will be contacted at the phone number provided on this application. Requesting Organization______________________________________ Contact Name______________________ Phone _______________ Mailing Address____________________________________________

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Is this donation request in association with a particular event? Y / N If so, when is the event? ____________________________________________ Please give the name of the event and a brief description or attach information: ________________________________________________________________ How will this donation be used? (I.e. silent auction, raffle,)__________________ What are you requesting? ___________________________________________ Has Chick-fil-A contributed to the organization in the past? Y/ N
The undersigned hereby certifies that (a) the information in this application is correct to the best of his/ her knowledge (b) that the donated merchandise will be used for the project outlined in the application (c) each person only receives one Be Our Guest Card. These cards are not intended to provide one person or family with free food for or a week or month, but to reward someone for a single event or accomplishment. Thanks for your cooperation in adhering to this policy.

X________________________ Signature Mail or fax to: Fax (405) 742-2112 Chick-fil-A at Stillwater FSU
600 E Hall Fame Stillwater, Ok 74075 405-742-2111

__________________ Date

Approved _____ Rejected _____ Date filled ___________________________

For questions or comments, please contact us via e-mail at 01973@chick-fil-a.com