Community Support Request

I have a local worthy cause that I would like Owen Cleaners to consider supporting. I am submitting this request with the understanding that Owen Cleaners, Inc. retains the sole right to accept, modify or decline my request.

This form is currently under construction. Please use the paper based form.

Name of Organization/Event (required):
If an event, Please Provide date, time and location:
Type of Organization/Event

Contact Information:
Street Address:
City: , State:
Zip:
Telephone: , Fax:

Organization Details
Name of Organization/Event Leader:
Name of Person Submitting Request:
Position with Organization:
Requester's Email Address:
Organization Website:

Type of Support Requested:

Date a Decision is Requested:
Date Ad or Gift Must be Received:
Suggested Amount of Donation:

The proceeds of donation will go to: (explain organization, fund, purpose, etc):

Upon acceptance of my request for support by Owen Cleaners, my organization agrees to provide a written invoice or letter before payment of donation is requested:

The donation should be delivered by: Mail (to above address)Picked up in Person (in Lone Oak)

Other Comments: