Charitable Donations

Monetary Donation Request Form

Part 1: Contact Information

Organization

Contact Name

Title

Website

Address

City

State

Zip

Telephone

Fax

E-mail Address

Confirm E-mail Address

Part 2: Background Information

501c3 Number

Other Companies Involved

Mission Statement

Part 3: Donation Information

Desired Amount

Date Requested By

Will the organization receive
the monetary donation in
the form of gift cards?

How will the donation
be used?

How does this donation
promote Sears Holdings' mission
of Supporting our Heroes and
Communities?

Questions/Comments

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