Driving Away the Cold – Agency Compliance Form

The Driving Away the Cold New Coat Program beneficiary named below certifies that the procurement of these coats will support the charitable act of providing coats to children in need in the greater Philadelphia area. Recipient certifies that these coats will not be resold and will be provided for the benefit of children in need. Further, recipient certifies that the receiving organization qualifies under federal income tax section 501(c)3 of the IRS Code.

I, the undersigned representative of the below named organization, do hereby certify that I am authorized to provide the certification on behalf of this organization. Additionally, I understand that resale of the coats is strictly prohibited.

Organization Name*
Organization Address*
Street Address City State ZIP Code
Federal Tax ID# / EIN*
Are you a school? Just enter 'School' below.
Contact Name*
First Last
Phone*
Email*

Questions? Contact Jenn Jackson at jenn@adagp.com.