Beneficiary Request Form: 100 Women of Richardson

Beneficiary Request Form

Thank you for your interest in being a beneficiary of 100 Women of Richardson! We look forward to working with you!

Mission Statement:

To bring together at least 100 women to contribute financially several times per year to local nonprofits to make an immediate, meaningful and significant impact in Richardson, TX.

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* 1. Beneficiary Contact Information

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number

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* 2. Name of Organization who will benefit from the donation

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* 3. General Information about Beneficiary (Mission Statement; populations served)

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* 4. Specific Need or Project. Please explain exactly how you plan to use the donation

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* 5. ELECTRONIC SIGNATURE of COMMITMENT: The organization agrees not to use, give or sell the contact information of our members for additional solicitation by them or other organizations. The organization agrees to accept individual checks made out to their organization and to provide tax documentation to each individual member who donates for tax purposes.