Step 1 of 4 - Contact Info 25% Organization name (legal name)* Name of parent organization, if applicable (i.e scout troop or school district) Website URL of event or requesting organization (Format: http://www.example.com) Is your organization an IRS non-profit or public tax-exempt organization (i.e. schools, churches) as defined under Section 501(c)? Please select the appropriate type.*Please Choose OneNot a 501 (c)501 (c) Status Unknown501 (c) (1)501 (c) (2)501 (c) (3)501 (c) (4)501 (c) (5)501 (c) (6)501 (c) (7)501 (c) (8)501 (c) (9)501 (c) (10)501 (c) (11)501 (c) (12)501 (c) (13)501 (c) (14)501 (c) (15)501 (c) (16)501 (c) (17)501 (c) (18)501 (c) (19)501 (c) (21)501 (c) (22)501 (c) (23)501 (c) (25)501 (c) (26)501 (c) (27)501 (c) (28)What is your federal taxpayer ID number? Format: 12-3456789. If you are not a non-profit and don't have a Tax ID number (e.g. schools, faith based organizations and scouts), please just enter "12-3456789" to continue.* Contact Full Name* First Last Contact Phone Number (Format: 555-555-5555)*Contact Email* Organization Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Organization's Complete Mailing Address - Include all details for an envelope. This is where any donations (if approved) will be mailed if store pick-up is not available.* Year organization founded (Format: 1999)* Have you ever received a donation from Northtown Auto in the past?* Yes No Which of the following category best describes your organization?*Please Choose OneQuality of life & enhanced careChildren’s & youth initiativesAnimal care & rescueOther (please specify)If you selected Other, please specify belowAre any Northtown Auto employees currently connected with your organization? (If YES, please list names below)* Yes No I Don't Know Names of employees (if applicable) NOTE: Please be sure to save your work on this page if you will not continue to the next page for more than an hour. The system could time out and you will lose any un-saved work on this page. You can click "Save the Form" button at the bottom of the page and you will get an e-mail with a link. SAVE THIS EMAIL! This will allow you to come back and finish. You can also come back at anytime using that link and all your information will be available.What is the PRIMARY reason for this request? This will be what the donation will be used for. Please carefully review all choices before making the selection.Please Choose OneCapital campaignCommunity Project/EventEnvironmental effortFeeding the hungryHuman servicesMedical research or finding curesMembership DuesMentoring programsNutrition and/or wellness educationPet/Animal ServicesRegular education programming (K-12 or higher)Religious programsTravel expenses for a group or individualWorkforce developmentYouth sports and fitnessOtherWhat form of support are you requesting? Gift Cards Monetary Donation Product Donation Program Advertising Ticketing Service In-Kind (office equipment, etc.) Please list an estimated dollar amount or value of your request.Please provide a description of your request (i.e., gift basket, monetary donation, gift card, etc.)Which category best describes your request?Please Choose OneGeneral Operating SupportSpecific Program SupportEvent - Golf TournamentEvent - Gala (Table sponsor)Event - Conference / SeminarEvent - Run / WalkEvent - General Fundraising EventsWhat is your deadline to receive the donation?* MM slash DD slash YYYY Date of Event MM slash DD slash YYYY How do you intend to use Northtown Autos donation? Please note: we reserve the right to specify the use of our products.* Consumption Silent Auction Raffle Live Auction Gift Bags Prizes Direct Services Membership Dues Please indicate how you plan to promote this program or event.* Social media site(s) Web Site(s) Print Radio TV Other N/A - No media outreach planned. How will Northtown Auto be recognized for their donation?*Will an ad be included with our donation / sponsorship?* Yes No If you chose "yes" for an ad, please let us know the following: (Size: full, half, 1/4 or 1/8 page, Dimensions: W X H, Format: PDF/JPEG, Color: Color or B&W) If you are satisfied with the form, please click the "I'm Done!" button. Please note, if you need to upload files to Northtown, please use the link available in the E-mail or on the Thank You page (it will land you on this page after submitting). Δ
