Sales associate or employee name(s):
Office Mailing Address:
Brief description of event and activity(ies):
Brief description of specifically how this activity assisted the charitable organization(ie: food provided to how many families, $ amount of funds raised, # of warm coats collected, etc.):
Number of volunteer work hours:
Website (if any):
Note: This number will be used to verify applicant’s status as a qualified 501(c)(3) organization.