OmniTel Communications’ Charity Grant Program 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?*FloydGreeneLittle CedarMarble RockNew HavenNora SpringsPlymouthRock FallsRicevilleRockfordRuddSt. AnsgarStacyvilleMcIntirePerson making request*All requests MUST come from a current OmniTel customer.Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Check to be made out to*Do you (or does this organization) have a presence on Facebook?*YesNoWe strongly encourage that at least one member of the organization requesting an OmniTel Charity Grant have a Facebook presence so they can use OmniTel’s Facebook Wall to promote their project. We believe that posting a description of the project, explaining how this project will benefit others and posting periodic updates of the project’s progress is another way in which the organization can make and maintain strong community connections.Would this organization be willing to post periodic updates on OmniTel's Facebook Wall?YesNoIf you or your organization does not have a presence on Facebook, email us at email@example.com and we will be delighted to help you. Thank you for your request!NameThis field is for validation purposes and should be left unchanged.