Community

Organization Name *

Contact Name *

Contact Title

Address *

Address 2

City *

State *:
South DakotaNorth DakotaMinnesota

Zip Code *

If Other, please explain *

Daytime Phone *

E-mail Address *

Fax Number

EIN or Tax ID Number of Organization

501(c)(3) Number (If applicable)

Wheat Growers location(s) in your community:

Requested Amount *

Donation needed by the following date:

Briefly describe how your requested donation will be used and
why it is needed. *

Briefly describe what you hope to achieve with the use of your requested donation.

* Required Fields