Donation Request

Donation Request Form

Donation Request

Request for OSHC Foundation, Inc. Donations

Date: _____________

Requestor’s Name: ______________________________

Organization to Receive Products, Services or Funds:

Organization Name: ________________________________________

Address: ________________________________________________

_________________________________________________

City/Province/Zip: _________________________________________

Country: ________________________________________________

Explanation of Need for the Donation:

________________________________________________________________

Are there documents supporting the need? ___ Yes ___ No

If yes, please attach the documentation.

Submitted by: ________________________ ____________________

Name Title

Approved by: ____________________________ Date: __________

(Officer OSHC Foundation, Inc.)

If not approved, why? ________________________________________

________________________________________________________________

Value of product, services or funds to be dispersed: ____________________

Submit the completed request to any one of the following Foundation officers:

Phil Rank Jack Hagen Hector Kitscha

W7056 Elk Road 1949 Surrey Lane 8460 Midland Court

Westfield, WI 53964 USA Grafton, WI 53024 USA Greendale, WI 53129