Charity Information Request Form

In compliance with the BBB Privacy Policy, the BBB of Utah will use the personal information you provide below only for the purposes for which you have given permission.

Please provide the following information about your organization. A BBB Charity analyst will review the information you provide and then send you further information by mail, including a BBB Charity Evaluation Questionnaire, which will allow to provide the information that the BBB needs to evaluate your organization.

What is the organization's official name? *

Please identify any alternative names that are used for fund raising and/or other purposes:

Names

Please identify any former names for your organization:

Names

Organization's physical address:

Address 2:

City: * State: * Zip: *

Second Address

City State: Zip:

Public phone number:

**
###-###-####

Public phone number 2:

*
###-###-####

Fax

*
###-###-####

Web Site: Address (URL)

Year of Incorporation:

*Please enter a valid year.

State of Incorporation:

What is the scope of your organization's fund raising activities? *

International

National

Regional

Local

What is your federal tax ID number? (##-#######) *

*	Our organization does not have a Federal Tax ID

In how many states is your organization registered to solicit for charitable contributions: *

Please provide information about the person who will be filling out the Online Charity Questionnaire, and who we should contact with any questions:

Name:	*
Title:	*
Phone number:	** ext: * ###-###-####
Fax number:
E-mail address:	***

Charity Information Request Form

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