Donation Request Form

CPI is dedicated to adding value to and sharing success with our patrons and local communities by contributing to their programs and organizations. Per board policy, reasonable contributions can be made to charities and other non-profit organizations.

*Required Fields

*Date Donation Required By:

*Applicant Name:

*Applicant Phone Number:

*Applicant Email Address:

*Check Made Payable To;

*Send Donation To:

*Address:

*City:

*State:

*Zip Code:

*Description:

Please give a detailed description of your donation needs and how the donation will be utilized.

*Upload Supporting Documents:

Please select a file

This could be a flyer, letter, or additional information about the donation request.

*Will specific mention be made of our support?:

Yes (describe below) No

Security Code:

Prefer A Paper Copy?

Download & print our Donation Request Form and mail to:

CPI Donations

PO Box 1008

Hastings, NE 68902

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