Big E's House :: Giving Back Program Application

*Denotes Required Information

Organization Name*	Contact Name*
Address*
City*	State*	Zip*
Phone*	Fax
Email*	URL*
How long has your organization been in business?*	How many active members are in your organization?*
What percentage of every dollar goes directly to the assistance of animals?*
Please provide 3 references of individuals or organizations that your organization has worked with in the past (please list name and phone number or e-mail*
Please list the yearly events organized by your organization.

Note: You will need to provide proof that your organization is a 501(c)3 nonprofit organization.