West Side Nut Club, INC - Funding Request

Thank you for your interest in the West Side Nut Club, Inc. Please fill out the below request form for consideration of funds.

Please SCAN all documents and upload vs taking a picture.

Deadline for request

Name of Your Non-Profit Organization

Your First and Last Name

Contact Phone Number

Your Contact Email Address

Organization's Address

Year Non-Profit was established

Short Description of your Non-Profit's Mission and Community Impact

Type of Request

Financial

Physical

Other

Short description of how the funds will be utilized

The amount requested

Estimated Number of individuals that will benefit if the request is granted

Have we donated to you before?

If so, when?

Pursuant to the Indiana Code Sec 4-32.3-2-32, donations may only be given to qualified recipients.
To verify qualified status, the West Side Nut Club, Inc, requires the following documents to be
submitted with your funding request:1. A completed Form w-9 Form W-9 is required to be
completed to obtain the taxpayer identification number and entity type of a U.S. entity or
organization and to request certain certification and claims for exemption.

Please NO Pictures MUST Be Scanned and Uploaded

Copy of your entity IRS determination letter This determination letter will state the
code section under which your entity is determined to be tax exempt by the IRS.

Please NO Pictures MUST Be Scanned and Uploaded

Please provide any additional supporting documentation ie pictures, videos, etc

West Side Nut Club, INC - Funding Request

About Us

Navigation

Contact Information

Donations