Non-Profit Sponsorship Request Form

Sponsorship Request Form

Please fill out the form below to request a sponsorship or donation from one of our cancer centers. We request that you upload the sponsorship packet and any information that needs to be filled out at the bottom of this form.
DateTime
Your Name*

First NameLast Name
Your E-mail*
example@example.com
Is this request a sponsorship or a donation?*

SponsorshipDonationUnsure
Which center are you requesting a sponsorship or donation from?*
Requesting Organization Name*
Is all of the contact information listed below in the document you are uploading? (If yes, you do not have to fill out the contact information portion)*

YesNo
Requesting Organization Contact*

First NameLast Name
Requesting Organization Contact Email*
example@example.com
Organization Address to send check:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sponsorship Amount Requested ($)*
$200
Date Needed By*

MonthDayYear
Date
Payment Method:*

To Be Paid Via Accounts PayablePaid for by Personal Expense to be Reimbursed
The Accounts Payable (AP) process for requests requiring a manual check can take up to 15 business days after internal approval, contingent upon our bank's processing time.

For ACH payments, please upload the organization's ACH information below. ACH payments are processed within seven business days following internal approval.

If the organization can receive credit card payments, provide the donation link in the designated box below.
Online Donation Link
ACH Information

Cancelof
Upload sponsorship request form or brochure

Cancelof
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