ELKS THEATRE AND PERFORMING ARTS CENTER

COMMUNITY OUTREACH/ SCHOLARSHIP

DONATION REQUEST INFORMATION SHEET

 

The Elks Theatre and Performing Arts Center strives to support and promote the performing arts in the Prescott community. In order to help us expedite your donation request, please fill out the following form in its entirety. If you are requesting on behalf of a business, government, or non-profit organization please accompany this form with a descriptive letter written on official letterhead.  If you are requesting on behalf of an individual please include a type-written letter describing the reason for requesting the funds. 

 

Please note that a request does not guarantee funds will be distributed. Requests can only be delivered by U.S. mail. You will receive an email confirming receipt upon delivery to the Elks Theatre and Performing Arts Center. 

 

Thank you for your interest; if you need any further information or help completing this form please email request to info@etpac.com. 

 

MAIL ALL REQUESTS TO:

 

ELKS PERFORMING ARTS CENTER

ATTN: DONATION REQUEST 

117 E Gurley Street 

Prescott AZ, 86301 

 

NAME OF ORGANIZATION/INDIVIDUAL: _______________________________________

 

SUMMARIZE THE FOCUS OF YOUR ORGANIZATION:

 

______________________________________________________________________________

 

MAILING ADDRESS: ___________________________________________________________

 

PHONE NUMBER:_____________________________________________________________

 

EMAIL ADDRESS:____________________________________________________________

 

CONTACT PERSON:___________________________________________________________

 

ORGANIZATION ID#:__________________________________________________________

 

AMOUNT REQUESTED:__________________    DATE FUNDS NEEDED:______________

 

WILL THIS BE A RECURRING DONATION? :___________

 

IF SO, WHAT WHAT WILL BE THE INTERVAL?:_______________________

 

DO YOU CURRENTLY HAVE ANY OTHER DONORS?:__________

 

ADDITIONAL COMMENTS: ______________________________________________________________________________

 

______________________________________________________________________________

 

_____________________________________________________________________________


 

By signing this form I confirm that all statements made are truthful and all funds received will go solely to the organization and for the purposes laid out in the form. I understand that filling out this form in no way implies an agreement between the Elks Theatre and Performing Arts Center and the signee for the transfer of any money. I understand that this form will not be valid unless accompanied by a formal written request attached and sent via U.S. Mail. NO WALK-IN FORMS WILL BE ACCEPTED. 

 

NAME:_________________________________ 

 

TITLE:__________________________________


 

SIGNATURE:_____________________________   DATE:_______________