Community Support Application

Organization / Group Name *

Federal Tax ID Number *

Do you have 501(c)3 non-profit certification? *

Yes
No

Contact Name *

First

Last

Contact Title *

Organization Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Program / Event

Is there a print deadline? *

Yes
No

Date *

Do you need WST logos or ads? *

Yes
No

If yes, please specify. *

How many people are expected at your event? *

What cities or counties will be served? *

Please describe the nature and purpose of your program and event. *

WST DOES NOT use donations, advertising incentives, or gifts as an inducement to influence the outcome of ANY competitive bidding process regarding E-Rate or any other such benefit or discount for communication services. *

I agree with this statement.

What would you like Wheat State Technologies to donate? *

Make check payable to: *

Has Wheat State Technologies donated to your organization's program or event in the past? *

Yes
No

If yes, please provide date and amount. *

Our customers like to know how we support our community. How will WST be recognized as a sponsor of the organization/program/event? *