Charitable Contribution Request Form

Name of Organization: Date submitted: 7/19/2008 Contact person: Phone number: Mailing address: Person submitting this request: Phone number: Criteria for contribution requests: Only not-for profit organizations are eligible for charitable contributions and/or corporate support. DENSO cannot provide funding for general administrative costs, political, secular or religious purposes, conferences, trips or similar events. For future funding, all recipients of a contribution will be required to provide a summary to DENSO including how the money was spent, define objective and if it was achieved and percentage of the donation funding activity. Please provide contact person (should additional information be needed). Should this information not be included, future contributions will not be considered. We would like a receipt within 14 days of being awarded a check from DENSO. Amount requested from DENSO: $ Total project cost: $ Previous donations received from DENSO: Yes No If Yes, Year: Amount: $ Year: Amount: $ Year: Amount: $ Year: Amount: $ Total amount received from DENSO: $ Date contribution needed: What other sources are funding this activity: Do you receive funding from United Way? Yes No Who will benefit from this project/activity? The Community Relations Committee meets once a month. Please provide as much information as you can for our review process. All requests must have documentation of the 501c(3) status. You will be contacted if more information is needed or when a decision is made. Thank you for sharing your project with DENSO Manufacturing Michigan, Inc.