Building An Intelligent Community | The Intelligentsia Agency, Inc.

The Intelligentsia Agency, Inc. is committed to helping the community and the world in which we work. We are grateful for the opportunity to consider organizations that provide a benefit to their community for donations.

DONATION REQUEST FORM

Organization Info

Organization Name*:

Organization Country*:

Tax ID*:

Zip Code*:

Year Established:

Organization Type*:

First Name*:

Last Name:

Primary Phone*:

Street*:

City*:

State*:

Primary Email*:

Mission Statement*:

Website:

Requester Contact Information

First Name*:

Last Name:

Email Address*:

Primary Phone*:

Cell/Other Phone*:

Title/Relationship to Organization*:

Request Details

Please specify what the donation will be used for*:

Attach Documents

Please attach the following documents:
-Certified 501 (c)(3) document (Not Tax-Exempt form)
-Documents that describe your organization's need, or any other related document.
(Please use one of these formats PDF, doc, docx, xls, xlsx, less than 10 Mb per document)

Referred By (if applicable):

Comments:

Address to where donation should be mailed (if possible, please provide a commercial mailing address):
Mailing address is same as aboveSpecify mailing address below

Address:

City:

State:

Zip:

Country:

*Please Note*
Submission of this request does not guarantee that your request will be fulfilled. Status of requests will not be given over the telephone. Thank you.

I confirm that I am 18 years or older
(Please check this in order to be able to submit the form).