Charity Grant Program | Under $100 |

Charity Grant Request Under $100
* Name of Organization
* OmniTel Grants are for non-profit organizations only. Please provide your Tax Exempt Number
Cash Amount Requested
Donation Requested (i.e. items for gift bags, dial-up Internet )
* Reason for Request
* Date Request made
* Date Needed
* In which OmniTel community is this event or organization?
* Person making request
All requests MUST come from a current OmniTel customer.
* Address
* City
* State
* Zip
* Telephone
E-mail
* Check to be made out to
Thank you for your request:

* Required fields.