Application for Design Services


Contact Name:


Agency or Organization Name:


Address Line 1:


Address Line 2:


City:    State:    Zip:


Phone Number:


Fax Number:


Email:


Brief description of services your agency provides:


Description of project:


Has your board approved this project?   Yes    No


Board Contact Name:


Board Phone Number:


Please attach a PDF copy of your agency's 501c3 exemption Letter:


Is your agency insured?   Yes    No


Carrier Name:


Type of Coverage:


Please attach a PDF copy of your Insurance Certificate coverage:


Can your agency provide the following for this project?


Funding:    Yes    No


If yes, how much?


Trucking:    Yes    No


Trucking Contact Name:


Trucking Phone Number:


Days Available:


Volunteers? (Can include board members, staff and clients)    Yes    No


Please describe how your agency would benefit from PBD services:


When do you want the project to begin?


When do you need to be finished?


Please describe any unusual conditions regarding timing (e.g. leasing conditions, joint occupancy, funding, other):


List of furnishings requested:


Bookmark and Share
have a heart button
donate money button
volunteer button
Copyright © 2009-2011 Philanthropy By Design. All rights reserved.