Community Relations Advertising Request

* Indicates fields that are required.

Amount Requested

Requested Medium

Print Radio TV

Date Copy Due

Publication Date

Distribution Quantity

Please describe the primary function of your organization and the clientele it serves:

Please indicate breakdown of overall contribution dollars to this project:

To overhead operations

To benefit cause/constituents

Please describe why your organization is requesting a grant from Chief Supermarkets.

What food related sponsors are participating in this project?

Describe in detail your distribution plan:

Supporting documentation (optional)

Submission total must be smaller than 5MB

Organization

Address

City

State

Zip

Phone

Fax