Lodge Charity Account Application

Lodge Name *

Lodge Number *

ContactLodge Charity Account Representative (LCAR) *

LCAR Full Address (Include City, State and Zip) *

LCAR email *

LCAR Phone *

Project Category *

Project Description, Preservation or Almoner Name *

Date of Event/Presentation (if you have one)

Amount of Request *

Check Made Payable to: (Recipient Name) *

Recipient Address *

Recipient City *

Recipient State *

Recipient Zip *

Minutes from business meeting approving the withdrawal *

Drop your files here

Date Submitted *

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