Donation Request Form Please complete and submit the following to ensure a prompt reply to the donation/sponsorship request. OTIS FCU Donation Request Form Request date: Deadline for response from OTIS FCU: Name of requestor: First Last Phone:Requestor's affiliation with OTIS FCU: Member Spouse or child of member Other If other, please specify:Organization's name:Organization's phone:Organization's address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Has OTIS FCU contributed to this charitable organization in the past?YesNoIf yes, please specify most recent year, dollar amount, and/or additional donation item/volunteer services provided by OTIS FCU:What type of organization is it? Non-profit Church School Youth Individual Community Other If other, please specify:How many in your organization?How many participating?Is this organization National Regional State Local If local, please specify the name of the community:What type of services does this organization provide? Health services Welfare (financial aid, housing, food, etc.) Preservation of arts/culture Other If other, please specify:Will organization or project directly benefit a significant portion of OTIS FCU's members and potential members, and/or the communities in which they live?YesNoWill OTIS FCU receive public recognition from this organization or project?YesNoIf yes, in what way?If requesting advertising, please describe:If requesting cash, please specify amount:Cash donation should be payable to:If requesting auction item, raffle prize, or other merchandise, please describe:If requesting other, please describe:For what purposes would the donation be used?Additional comments: If you have any questions, please contact Sarah Hayes in Marketing at (207) 897-0900 ext. 123.