Donation Request Form

Please email a completed W-9 form to ap@bosselman.com once you’ve completed the donation request form.

The current W-9 form can be found at w9form-online.com.

URL

This field is for validation purposes and should be left unchanged.

Terms And Conditions(Required)

I ACCEPT THE FOLLOWING TERMS AND CONDITIONS: If my request is fulfilled by The Bosselman Enterprises of Grand Island, Nebraska, I agree to provide recognition of The Bosselman Enterprises, or its companies, in exchange for this donation, and, a receipt for the donation will be provided upon delivery. I understand that completion of this form does not guarantee that my organization will receive a donation. I understand that any requests must be submitted at least 30 days prior to the date the donation is needed in order to be considered, and I agree to refrain from contacting The Bosselman Enterprises to check the status of this request.

Organization Name(Required)

What is the nearest Bosselman Enterprises to your event or organization?(Required)

Is your organization a Tax Exempt 501 (C)3?(Required)

Yes

Tax ID Number

What type of group is your organization? (i.e. School Group, Non-Profit Organization, Sports Team, Business, etc. **Please note: Religious organizations/Churches, Personal causes, Trips, and Race Cars are not supported.)(Required)

Event Name(Required)

Event Location (City & Venue)(Required)

Date of Event(Required)

Time of Event(Required)

Event Description(Required)

Has Bosselman Enterprises assisted your organization in the past? If so, please state how, including dates and amounts or items.(Required)

Items and Amounts Requested? (Please be specific, i.e. Cash, Gift Cards, specific items or products, and include dollar amount requested.)(Required)

How will the donation be used to help your cause?(Required)

What is your expected attendance at your event, or how many people will be helped or affected by your cause?(Required)

How will Bosselman Enterprises by represented at your event or in recognition of this donation? Will our logo be featured?(Required)

Will you be able to provide photographs or videos to Bosselman Enterprises that demonstrates our support of the event?(Required)

Yes

Your Full Name(Required)

Address to send the donation, if via mail. Some items must be picked up at our Corporate Headquarters in Grand Island, Nebraska.(Required)

Email Address(Required)

Phone Number(Required)

All proposals will be reviewed within 30 days.
If your organization fits our criteria, we will respond within 30 days.

Please note: Our contributions are often in the form of Gift Cards/Vouchers that can be used at Pump & Pantry locations, or, may be branded merchandise. We may also offer you the opportunity to fund raise through our company.