Organization Organization: If applicable, CRA Registration #: Mailing Address Address: City: Province/State: Postal/Zip Code: Is is the same organization name and address to receive the donation cheque? Yes NoCheque Payable ToSame as mailing address Organization Name(Cheque Payable To): Address City Province/State: Postal/Zip Code: Contact Information First Name Last Name Title(Position) Email Address: Phone Number Fax Number Charitable Request Information How did you hear about Bison Transport's Charitable Giving process? Describe the reason for which you are requesting funding: Dollar amount you are requesting: What percentage of the funding will go towards the following: (Enter 0 for none) % Programs: % Fund-raising: % Administrative: % Held for future: Date funding is needed by: Are you receiving funding from any other sources? Yes No If yes, please indicate the name of other sources: Who will benefit from the funding? What is the number of people affected by the funding? Is there an event associated with this funding? Yes No What percentage of the total revenue for this event will go to the organization you are fundraising for?: What is the date of the event What is the location of the event? Do you have a budget for the year? Yes No If yes, please explain: What are your plans for following up with us with the results?: Please give a summary of your organization's background(i.e. Mission Statement, history): Describe your organization's financial accountability: Describe the ways that Bison Transport may/will be recognized for the contribution?: Are there any non-monetary support opportunities associated with this request?: Yes No If yes, please explain: Send RequestStay ConnectedStay up to date with the latest news from Bison Transport!
