About Agtegra Cooperative

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Donation Request Form

Date Requested:

Today

Organization Name:

EIN/Tax ID #:

Organization Mailing Address:

City:

State:

U.S. ZIP code:

Organization Contact Name:

Title:

Phone:

Email:

The Organization is (please mark):

501 c(3) - Please include a copy of your 501 c(3).
City/Government
School
Other - please describe

Area Served/Population:

Specific Project or need that request will aid:

Type of Donation Requested:

Monetary Amount $
Other - please explain

If Monetary Amount $:

Date Needed:

Today

Do you require our logo?:

Yes
No

If yes, what format?:

Event:

Yes - then complete the next four lines
No

Event Date:

Today

Type of Event:

Number of People Expected to Attend:

If the event is to be advertised, please tell us how it will be done:

Other information for our consideration:

501 c(3):

Flyer:

Additional Attachment:

Security code:

- Company
- Contact Us
- Careers
- Locations
- Agtegra Cooperative
  908 Lamont Street South
  Aberdeen, SD 57401-5155
  605.225.5500