Donation Request

First Name *

Last Name *

Name of Restaurant *

Amount Spent *

Date of Transaction *

Please select which charity you would like our matched earnings to be deposited:

United Way

Grand Rapids Community Foundation

Hand 2 Hand

Kid's Food Basket

By submitting this form, I agree to allow the credit union to share my participation in the marketing of this promotion.

Thank you.

Your Donation Request has been submitted!