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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