Charitable Donation

Requesting Organization Name:(Required)

Contact Person:(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email(Required)

Phone(Required)

Description of Request:(Required)

Requested Amount:(Required)

Description of how the funds will be applied/used(Required)

Total Project Budget(Required)

if applicable

Event Date

If applicable

Event Location

If applicable

Name of Impulse Dynamic Contact:

Or name of contact who referred you to this site, if applicable

Upload Request Letter(Required)

Max. file size: 24 MB.

Signed, and on official institution letterhead

Upload W-9(Required)

Max. file size: 24 MB.

Please upload a copy of your W-9

IRS Determination Letter (501(c)(3) certificate) or equivalent documentation of tax-exempt(Required)

Drop files here or

Max. file size: 24 MB, Max. files: 5.

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