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x x PENTWATER SERVICE CLUB
REQUEST FOR DONATION
P.O. Box 273
Pentwater, MI 49449
Request forms must be submitted to Mr. Brian Fillion
(Please print all information)
1. Date of this request:
2. Please provide the name of the organization (group) making this request.
3. Where is the organization located?
4. Please provide the name and telephone number of a contact person representing the organization making this request.
5. What is the amount of funding requested?
6. Please provide the date(s) when these funds would be needed.
7. How will these funds be used to benefit people living in the community?
(Please continue on the reverse side.)
Page 2: PSC Request for Donation
9. What is the total cost of the project to which these funds will be applied?
10. What other sources of funding are involved?
The Pentwater Service Club requires feedback on all donations made and will
expect your organization to notify the Club about the impact of these funds.
---------------------------------------------------------
(Service Club Use Only)
Finance Committee Review Date: Finance Committee Recommendation to Club:
Date Feedback Received:
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