Contribution Request

In order for us to consider your request, you must fill out this form and/or attach a fact sheet or request letter - the more we know, the better the chances of approval. Our Employee Committee meets to consider requests once a month.

Name of soliciting organization:*

Contact Phone Number:*

Contact Email:*

Address*

Street Address City State

Zip Code*

Tax Deductible Status: Federally exempt?*

Yes
No

When do you need the contribution?*

(If less than 30 days from the date you submit this form your request may not be considered in time).

Solicitor’s First Name*

Solicitor’s Last Name*

Relationship of organization:*

Employee
Volunteer
Paid Worker
Professional Fundraiser

What kind of service is rendered by your organization?*

What kind of recognition will result if we contribute to this cause?*

Has your organization (or you personally) purchased a vehicle from us?*

Yes
No

If yes, under what name?*

If yes, what year?*

Are you or your organization a regular parts/service department customer?*

Yes
No

Attachments

Signature*

Today's Date

By submitting your information, you agree to the sharing of your information between Genesis Motor America and its authorized retailers.

I understand I do not have to consent as a condition of purchase or to receive any services. By checking this box, I agree Genesis, Genesis retailers and/or their vendors may use the number provided to make telemarketing calls or texts via automated technology. Carrier charges may apply.

Your Email

This field is for validation purposes and should be left unchanged.

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