Kocourek Kids Contribution Request

Kocourek Group Outreach… Dedicated to giving back to the community. Kocourek Automotive believes it is important to individually address each contribution request.   However, because of the literally hundreds of requests that we receive Kocourek Automotive has established the following required contribution request form. Click here for a print friendly document.

DONATION REQUEST FORM

Completion of this form is a request only and does not guarantee a donation.  In order to be considered, donation requests must be received a minimum of 6-8 weeks prior to the event. Only approved request will be notified.

Organization Name:______________________________________________

Address:_______________________________________________________

County:_____________City:____________________State:______Zip:_____

Telephone: (___) _____-_____          Fax: (____) ______-______

Type of Organization: (please check one)

____Animal Welfare     ____Church        ____Arts & Culture             ____Civic & Community _____Government/Military 

____Athletic  ____Education   _____Business ______Health & Human Services  ____Environment/Agriculture

Tax Exempt#/501c3 (attach documentation)__________________

Contact Name:___________________ Contact Telephone (______) _____-______

Event Date:_____________  Event Name:_________________________________

Event Location:______________________________________________________

Description of Event:__________________________________________________

Item to be used for: (Please check one)

Door Price:________   Incentive:________ Silent Auction:_______   Raffle:_____

Live Auction:_______  Other:________________

Donation Shipping Address:_____________________________

Attention:___________________________________________

Address:____________________________________________

City, State, Zip_______________________________________

We give back because we can, because we care and because we believe that everyone doing a little can accomplish a lot.  Enhancing the lives of those around us is both a responsibility and a privilege.