Sheridan Insurances 2020 Charity/Community Partner Application
Name
First Name
Last Name
Your Group/Charity Name
Registered Address
Street Address
Street Address Line 2
City
County
Eircode
Contact Number
Email Address
example@example.com
Are you a registered charity
Yes
No
Registered Charity Name & Number
Please tell us about your charity/group and how our funding would help you
I wish to confirm that Sheridan Insurances may contact me by any of the following means
Email
Phone
Text Message
Post
Date
Completed Date
-
Day
-
Month
Year
Date
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
:
Hour
00
10
20
30
40
50
Minutes
Submit
Should be Empty: