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Your Name

Mary Giese

E-mail

mcgiese@mchsi.com

Phone Number

(641) 485-7457

Rotary Club Name

Rotary Club of Marshalltown

Beneficiary Organization Name

Marshalltown Community School District

Is the Beneficiary Organization a 501(c)(3), school or church?

Yes

Beneficiary Tax ID # (EIN)

school

Each year, we are required to report on our IRS 990 filing the number of volunteers who support our work. We need your help to have an accurate report. Approximately how many people will be involved in your coat giving program this year? Please include any of your paid staff who may be involved.

65

Billing Address for Donation Request

Street Address: P.O. Box 64
City: Marshalltown
State / Province: IA
Postal / Zip Code: 50158
Country: United States

Ship To Address (coats may ship “care of” an intermediary who receives the coats on behalf of the beneficiary)

Street Address: Marshalltown Fire Department
Street Address Line 2: 107 S. 1st Avenue
City: Marshalltown
State / Province: IA
Postal / Zip Code: 50158
Country: United States

Ship To Contact

David Rierson

ShipTo Phone

641-754-5751

Ship To E-Mail

drierson@ci.marshalltown.ia.us

Is this a commercial or residential address?

Commercial

For orders over 30 boxes, do you have a loading dock?

No

Special Delivery Instructions?

Please deliver coats to the back door.

Requested Delivery Date

Boys 2T

0

Boys 3T

1

Boys 4

1

Boys 5/6

2

Boys 7/8

4

Boys 10/12

6

Boys 14/16

6

Girls 2T

0

Girls 3T

1

Girls 4

1

Girls 5/6

2

Girls 7/8

4

Girls 10/12

6

Girls 14/16

6

Mens S

1

Mens M

3

Mens L

2

Mens XL

1

Mens XXL

1

Womens S

2

Womens M

2

Womens L

2

Womens XL

1

Womens XXL

1

Childrens Coats Boxes Ordered

40

Childrens Coats Ordered

240

Adult Coats Boxes Ordered

16

Adult Coats Ordered

96

Minimum Donation $

5568

Additional Donation $

Total Donation $

5568

Comments & Special Requests