Donation Request Form

As part of our mission at Southeast Farmers Cooperative, we are intentional in our support of youth, agriculture and community organizations and events. If you are interested in receiving funding from Southeast Farmers, please fill out this application as complete as possible. You may include any additional information or materials to support the requested funding. Be sure to include all necessary contact information. Completing this form does not guarantee funding. Please allow at least two weeks for approval of funding.

*Required Fields

Organization

*Organization:

*Street Address:

*City:

*State:

*Zip Code:

*Is the organization a:

501(c)(3) Charity School/Sports Team City Government Other

If other, please describe organization:

Contact Person

*Contact Person:

Title:

Contact Email:

Contact Phone:

Request Details

*Amount requested from Southeast Farmers:

*Describe the mission of your organization:

Explain the project/purpose of the requested funds:

Explain your fundraising efforts:

Total cost of project/fundraising goal:

Anticipated completion/event date:

*Will donors be recognized?:

Yes No

Is there a deadline for funds?:

Yes No

If yes, what is date of deadline?

reCAPTCHA