The information contained in this statement is for the
purpose of obtaining funding from The Energy Cooperative Round Up Foundation,
Inc. on behalf of the undersigned. Each undersigned understands that the
information provided herein is used in deciding to grant funding, and each
undersigned represents and warrants that the information provided is true and
complete and that The Energy Cooperative Round Up Foundation, Inc. may consider
this statement as continuing to be true and correct until a written notice of a
change is provided. The Energy Cooperative Round Up Foundation, Inc. is
authorized to make all inquiries they deem necessary to verify the accuracy of
the statements made herein. Please note that for the organization or agency who
receives funding: 1) The Energy Cooperative Round Up Foundation, Inc. publishes
the name, amount and purpose of funding granted. You may also be asked for a
photograph for public relations purposes. 2) We also ask that you provide the
Foundation with information to substantiate the use of funds awarded, such as
copies of invoices, pictures of equipment purchased, or a statement describing
specifically how the funds were used.