Donation Request

Today's Date: 
Date of Event (or) Date Support is Needed:  
Name of Organization: * 
Organization's Phone: *  
Address (Mail Check To): * 
Phone Number: *  
Email Address: *  
Is this organization:


Is this organization a customer of Dakotaland Financial Services?: *
 
Does this organization receive United Way funds?:
Will Dakotaland Financial Services receive any recognition | public relations?:
If so, in what way?:
Has Dakotaland Financial Services given support to this organization in the past?:
How was the support declared through a donation of?:


Support requested (complete all that apply): *


 
Please provide description for the support requested above: * 
For what purpose is the support to be used for?: * 
Validation:
(For Spam Prevention)