Chicago Donation Form

Due to our donation policy and budget requirements, please submit all requests at least 60 days prior to event.

Organization Name *

Organization Phone Number *

Area Code Phone Number

First & Last Name, Title of Applicant *

Ex: John Doe- Race Director, Jane Doe- Volunteer

E-mail of Applicant *

Phone Number *

Area Code Phone Number

Additional Contact

Ex: Sally Smith- Sponsorship Coordinator

Additional Contact E-Mail

example@example.com

Additional Contact Phone Number

Area Code Phone Number

Organization or Event Website

Is your organization 501(c)(3) certified? *

Yes No

If yes, please provide your federal tax ID number. *

If no, put N/A.

Name/Type of Event *

Ex: Auction, Fundraiser, "Healthy Mind 5k"

Date of Event *

Month Day Year

Which Gearhead store is your event closest to?

Location of Event *

City, State, Venue

Brief Description of Event *

Which of the following are you seeking? *

Monetary donation Silent auction item(s) Gift card(s) Door prizes Race sponsorship Other

If other, please describe

If you are applying for a race sponsorship, please provide sponsorship levels.

Please provide a detailed explanation of the donation you are seeking *

How will you promote Uncle Dan's support of this event? *

What makes Uncle Dan's the ideal partner for this event? *

Are there any Uncle Dan's employees involved with your organization? *

Has your organization helped with a Uncle Dan's event before? *

Yes No

If yes, which event?

Would you or your organization be willing to help with a Uncle Dan's event or race in the future? *

Yes No

Are you requesting volunteers for the event? *

Yes No

If so, how many?

What will the volunteer duties entail? *

For what time slots will you need volunteers? *

Additional Information (i.e. Sponsorship packet, donation letter, etc):

Donation Request Form