General Contact

Organization Name

Organizatioin is required.

Date

Date is required.

Address

Address is required.

City

City is required.

State

State is required.

Contact Person

Contact is required.

Title

Email Address

Email is required.

phone

Phone is required.

Campaign/Event

Event is required.

Amount Requested

Phone is required.

Purpose of request*

A purpose is required.

Are you a 501.c.3 organization: (If yes, please mail a copy to IC Federal Credit Union, 300 Bemis Road, Fitchburg, MA 01420 Attn: Marketing)

Phone is required.

Organization Brief History:*

A comment is required.

Does your organization or any of its officers have an account relationship or partnership with ICFCU? If yes, please explain:

Phone is required.

What recognition opportunities are available to IC if this requested is approved? (banner, flyers, radio, etc.)

Phone is required.

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