Contribution For:

Benefactor's Federal Tax ID:

Community that will benefit:

Donation Deadline:

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Full Name:

Mailing Address:

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Country: (Select One) USA Other

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Kimball Employee: (Select One) Yes No

Giving Category (Select One) Education (pre-school, elementary, high school and university levels) Health & Human Services Civic & Community Programs Arts & Culture Religious Institutions (non-denominational, all inclusive) Other

Reason for Request: (Select One) Certified 501(c)3 Organization Fundraiser (American Cancer Society, etc) School Fundraiser (non-sports related) Community Fundraiser Local Civic Fundraiser Sports Fundraiser & Benefit Religious Institution Capital Campaign, Building/Renovation Project Personal Fundraiser & Benefit Other

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Requested Amount