Equitable Gives

Organization Name:

Contact Name::

Contact Phone Number:

Contact Email:

Address:

City:

State:

Zip Code:

Organization Website:

Organization Mission Statement:

Briefly describe why you are requesting funds and how they will be used to reach your goal:

Is the organization a recognized 501 C 3?
yesno
What Communities do you serve?

Do you have a connection to Equitable Mortgage?
yesno
Have you received a donation from us in the past?
yesno
Are the funds requested for an event or general donation?
event donationgeneral donation
If an event, please describe event goal and sponsorship opportunities:

If a general donation, please explain what funding will provide:

Donation/Sponsorship Request Amount: $

Please feel free to add more information on the organization and upcoming plans.