Please print & fill out the form below

Heritage Homes of Petaluma

Today's date: _______________________

Name of organization requesting grant:

___________________________________

Contact name, address, telephone & email:
Name:_______________________________
Address:_____________________________
____________________________________
____________________________________
Telephone:___________________________
Email:_______________________________
Website:_____________________________

Is the organization non-profit or commercial?:
___________________________________

Amount requested & date funds are needed by:
$_______________ Date needed:__________

Intended purpose of grant and how will this
help historic preservation in Petaluma? Please
fee free to attach a separate sheet if necessary.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Will Heritage Homes be a noted sponsor for the project?
Yes_____ No_____

*Please mail completed form to:

Heritage Homes of Petaluma
P.O. Box 1252
Petaluma, CA 94953

For Heritage Homes of Petaluma Use Only

Approved as requested: Yes______ No_______
Approved with the following guidelines:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Check issued on:_______________________