Admin Matching Grant Form

Name of Organization receiving Matching Grant(Required)

Matching Grant Amount(Required)

(Minimum Matching Grant: $500)

Donor First Name(Required)

Donor Last Name(Required)

Spouse/Partner First Name

Spouse/Partner Last Name

Company/Business

Donor Name for Website

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Email used to send confirmation email

Phone(Required)

Is this gift anonymous?

Yes

If yes, Give! Pikes Peak will not publish or share donor information

I want to pay the 3.5% service fee

Yes

Payment Methods(Required)

eCheck

Check (Mailed)

Billing Address is Different?

Yes

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country