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56 Dallas Village Shopping Center, Dallas, PA 18612, USA

clocks1968@gmail.com

570.675.6507

Request for Donation or Sponsorship

We are a proud supporter of many organizations throughout the Back Mountain and Northeastern Pennsylvania. In an effort to properly review the large number of requests, we ask you to fill out this request form.

Name of Organization

Contact Name

How long has it been in existence?

If yes, tax ID

Contact Phone

Please note: this isn't a deal breaker, we'd just like to know

Name of Event

Date

Location

Description

If yes, how many times?

How will you promote this event?

Approximately how many people will attend this event?

How will the proceeds be used?

Please explain:

What else does your organization do to earn money?

What other marketing opportunities are offered for sponsors?

How do your support (promote) your sponsors?

We will review all requests the 1st of each month. If your request is approved, our representative will contact you by the 15th of the month.