Sponsorship and Donation Request

Completed forms can be emailed to community@coastepa.com or mailed to: Coast Electric Attn: Ana Brett PO Box 2430 Bay St. Louis, MS 39521 - Contribution requests must be submitted in writing on official letterhead of requesting organization, accompanied by Coast Electric Power Association Sponsorship and Donation Request Form. - Contribution must benefit members of and the area served by Coast Electric. Area is defined as Hancock, Harrison and Pearl River counties. -For consideration, Coast Electric Sponsorship & Donation Request forms must be received at least 30 days prior to date needed. Incomplete applications will not be considered. - Coast Electric reserves the right to approve requests at its discretion. - This institution is an equal opportunity employer and provider.

Organization*
Date Response is Needed*
Contact Name*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone and/or Email Address*
Types of Request*
- Monetary
- Goods/Services
Amount requested or type of service requested*
If granted, how will the contribution be used?*
Who benefits directly from the contribution?*
Has Coast Electric sponsored your event/organization in the past?
- Yes
- No
Additional information/comments
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Please provide any supporting documents
Name*
First Last
The above is correct to the best of my knowledge, and if the donation is approved, the goods and/or money will be used solely and expressly for the purpose listed.