Donation Application Form

Donation Application

Requester’s Name

First Name

Last Name

Requester’s Phone Number

Requester’s Email Address

Organization Name:

Event Name If Applicable:

Request Type:

Monetary Donation

Raffle Basket

Monetary Amount Requested:

Has Wabash Communications donated to or sponsored this organization/event in the past?

Yes

Date Needed By:

Supporting Documentation - Please upload supporting documentation, such as a flyer, request letter, sponsorship information, etc.

Maximum file size: 62.91MB

Extra Information/Notes:

If you are human, leave this field blank.

Phone

618-665-3311

Toll Free

(800) 228-9824

24/7 Customer Support

info@wabash.net

Monday - Friday

8:00 a.m. to 5:00 p.m.

14415 US HWY 45
Louisville, IL, 62858

610 S College St
Salem, IL, 62881

113 Hagen Drive
Flora, IL, 62839

102 N Main Street
Dieterich, IL, 62424

“This institution is an equal opportunity provider and employer.”