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Please fill in the following information about your organization. Then submit your request.
Organization' Information
Organization's Name:
Street:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Federal Tax Exempt number:
Your Organization's
Web site Address:

What is your organization's purpose?



Contact Information
First Name:
Middle Name:
Last Name:
Title:
Phone Number:
Fax Number:
E-mail Address:


Funding Information


 Purpose of your request.



Address where you would like the donation sent
(please, no P.O. boxes)

Street:
City:
State:
Zip Code:


Has your organization received Lands' End support in the past?
yes no

If so, please describe the support.



List of other corporate donors.



Other Fundraising Activities.



Your objectives and measurable, anticipated outcomes.



Describe how this grant will be utilized
(operating funds, projects, events capital).


Acknowledgement of funding from United Way?
yes no

Type of donation requested
Cash    Gift Certificate    In-Kind    Volunteerism

Note amount $ .00

Please tell us anything else we should know about your organization, including a description of your volunteerism opportunity.


After reviewing your request, we may ask you to submit the following:
• Photocopy of Letter of Determination (provided by the government) or most recent 990 form.
   Example: 501(C)(3), 509(a)(1).
• Itemized budget for the requested activity.
• An audited financial statement or annual report.
• Please also include a copy of your donation appilication.


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