Donation Requests Name * First Last Email * Donation Level * $0-$250$251-$1000 Requested Amount Organization Contact Name Title Property Address Street Address Address Line 2 City State/Province Postal Code —Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsChadChileChinaColombiaCongoCook IslandsCosta RicaCote D IvoireCroatiaCruise ShipCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaFrench West IndiesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuernseyGuineaGuinea BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKuwaitKyrgyz RepublicLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMauritaniaMauritiusMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueNamibiaNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint Pierre & MiquelonSamoaSan MarinoSatelliteSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSouth AfricaSouth KoreaSpainSri LankaSt Kitts & NevisSt LuciaSt VincentSt. LuciaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor L'EsteTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & CaicosUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVenezuelaVietnamVirgin Islands (US)YemenZambiaZimbabwe Country Phone Is the Organization a registered 501 (c) 3 or 501 (c) 6? If not, Is there a fiscal sponsor? What is the mission/vision of the organization? If awarded, please describe the planned usage of funds? How is your planned usage of funds connected to Horch Roofing's yearly planned giving theme? Horch Roofing Recognized – Please describe the avenues that Horch Roofing will be recognized for the donation? Last fiscal year audited Profit and Loss Statement – Current Profit and Loss Statement Board list and paid staff list
