Request For Contribution
Organization Name
Are you looking for support or to donate a system?
*
Looking for Support
To Donate a System
Date of Request
*
mm/dd/yyyy
Support Need By
mm/dd/yyyy
Street Address
City
State
Zip
Phone Number
Webpage
What type of clinic/organization is it?
Non-profit
University
Private Clinic
Shelter/Humane Society
Other
If Non-Profit, please provide 501(c)(3) number:
Briefly describe your clinic or organization's mission:
Position/Job Title
Point-of-Contact Phone Number
Point-of-Contact Email
Is this clinic or organization a customer of (select all that apply):
What type of contribution are you looking for (select all that apply)?
Briefly describe your request and how the contribution will be used:
Since we receive a lot of requests, our ability to contribute your clinic or organization is dependent on our availability and cost. We want to help as many as we can and are better able to offer our contribution if clinic's or organizations are able to pay a portion of the cost associated with the contribution. We do our best to work with you to provide an option that will work best for your clinic or organization.
Since we receive a lot of requests, our ability to contribute your clinic or organization is dependent on our availability and cost. We want to help as many as we can and are better able to offer our contribution if clinic's or organizations are able to pay a portion of the cost associated with the contribution. We do our best to work with you to provide an option that will work best for your clinic or organization.
Is the clinic or organization able to help with cost?
Yes
No
If Yes, how much?
If No, Please explain your situation:
If Contribution Application is approved, are you willing to work with us on PR which may include: Social Media, Pictures & Videos for our Website and/or Marketing Materials?
Yes
No
Will you provide case studies utilizing the equipment or lab results?
Yes
No
Will there be a Veterinarian onsite for use with any donated equipment?
Yes
No
How did you hear about SOUND Technologies?
By submitting this Contribution Application you agree to and understand the following. Your application will go through a review process before a decision is made to approve or reject your request. Contributions are based on current availability of equipment, labor, and cost associated. You are willing to collaborate to come up with a suitable cost for both parties if needed.
By submitting this Contribution Application you agree to and understand the following. Your application will go through a review process before a decision is made to approve or reject your request. Contributions are based on current availability of equipment, labor, and cost associated. You are willing to collaborate to come up with a suitable cost for both parties if needed.
*
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