Vote With Your Dollars Application

Any organization seeking a Rutter's Children's Charities Donation must meet the criteria listed below and complete this form.

Criteria for Rutter's Children's Charities Donation Vote With Your Dollars Program

* Donation must be used for a capital project, assets or other large purchase; may not be used for operating expenses.

* Charity must be a 501(c)(3).

Please understand your organization must be 501(c)3 tax exempt and not every organization is right for this program. After a careful evaluation of your application, we'll decide if it's in both our best interests to move forward with Vote For Your Dollars for your organization.

Organization Name

Organization Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

501(c)(3) Tax ID Number

Organization website

Contact Name

First Name Last Name

Role within the organization

Contact Phone Number

Area Code Phone Number

Contact E-mail

Indicate the amount you are seeking to fund your project

$500-$5,000 $5,000-$10,000 $10,000-$15,000 $15,000-$20,000 $20,000-$25,000 Other amount not listed indicate below. (Maximum request may not exceed $25K)

Other amount not listed

Give a detailed description of the project to be funded. (Please note, requests must be for a capital project , asset or other large purchase and may not be used for operating expenses.)

Include your organization logo or letterhead, website, mission and goals, what the donation is for and the financial commitment requested. Requests are accepted on a rolling basis and if selected will be awarded in September.

Office Use Only

VOTE WITH YOUR DOLLARS Application