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Community Fund Form

Every space needs to be completed, and a financial statement MUST be attached (unless otherwise stated).
*At this time, our resources do not allow for capital improvement projects*
Next Quarter Application Due Date:  June 14, 2023
Community Fund
Physical Address of Organization
Physical Address of Organization
City
State/Province
Zip/Postal
Mailing Address (if different)
Mailing Address (if different)
City
State/Province
Zip/Postal
Is organization exempt from payment of income tax?
Is organization deemed a Not for Profit approved by IRS?
$
Please include a decimal point
Maximum upload size: 33.55MB
1666 West State Road 54
Bloomfield, Indiana 47424

Hours:  Monday – Friday, 7:30 a.m. to 4:30 p.m.

Office: (812) 384-4446
Toll-Free: (800) 489-7362
©2021 Utilities District of Western Indiana REMC. Member-Owned. Member-Focused.