Equifax Matching Gift Form Section A To be completed by the Equifax donor/giver To ARC Foundation Charitable Trust - Head of the Hooch-Row for the Cure ____________________________________________________ (Name of recipient Organization / Agency) Address 1425 Market Blvd. Suite 330 - #244 ____________________________________________________ ____________________________________________________ Roswell, GA 30076 I enclose the following contribution $ ______________ (Minimum $50) Donor’s Name ___________________________________________________ (type or print) Donor’s Signature ________________________________________________ Employee ID # _______________ Employment Date __________________ Home Address ___________________________________________________ ___________________________________________________ Equifax Location _________________________________________________ Business Phone __________________________________________________ Company # ___________________ Department # __________________ Section B To be completed by the recipient organization / agency. Agency Name ____________________________________________________ Mailing Address __________________________________________________ __________________________________________________ Agency Category _______ Arts _______ Civic ________ ED ________ HHS Date Received ___________________ Form of Gift ________ Cash ______ Check _______ Securities* *# Shares _______________________________ Securities Title ___________________________ Market Value $ ___________________________ Amount of Gift $ ____________ (Please include a copy of your 501(c)3 letter) Certified by _____________________________________________________ (Please type or print name) Signature _____________________________________________________ Title _____________________________________________________ Return form to: Equifax Community Relations 1550 Peachtree Street, N.W. Atlanta, Georgia 30309 The Equifax Foundation funds a Matching Gift Program which will effectively double the contributions our employees to eligible nonprofit organizations within the areas of arts and culture, health and human services, civic and community concerns and education. Our Matching Gift Program and Philosophy The Matching Gift Program is designed to enable employees, acting on their own initiative, to direct a part of the foundation budget which reflects their personal philanthropic interests. Individual gifts ranging from $50 to $5,000 per participant will be matched dollar for dollar each calendar year. A Matching Gift form must be completed for each donation. By involving more employees in the decision-making process, the Company is assured that corporate giving will better reflect the values of its people and be more responsive to the local needs of the communities where employees live and work. Eligible Organizations Not-for-profit U.S. organizations recognized by the Internal Revenue Service as tax-exempt under Section 501 (c) (3) of the IRS code are eligible for matching gifts. These organizations include arts and cultural institutions, civic and community organizations, health and human services organizations and educational institutions. Ineligible Organizations Excluded from the Matching Gift Program are: individuals; labor, athletic, social, political, veteran, fraternal and religious groups; fundraising benefits, dinners, exhibits, conferences and sports events; charities sponsored solely by a single civic organization; and those organizations identified by the Philanthropic Advisory Service of the Council of Better Business Bureaus as having questionable financial practices. Examples of organizations Equifax does not support are: organizations or programs which pose a potential conflict of interest for the company; churches or religious organizations (however, non- denominational programs sponsored by a church or religious group such as a camp, community center, hospital, youth home, etc., are eligible); athletics including scholarships for college and university athletic associations; athletic and band boosters, for-profit associations or social organizations that provide a service like Junior Leagues, Kiwanis, Lions, Rotary, etc. How To Make Your Matching Gift Equifax will match gifts made in cash, stock or securities. The contribution must be given, not merely pledged. Payment can be made by check, money order or securities. For securities, you will need a photocopy of the securities certificate along with the Matching Gift form**. Here are steps to participate in the Matching Gift Program: Complete Section A of the Matching Gift form and mail it with your gift directly to the nonprofit organization. That organization/agency/institution will then complete Section B of the form, enclose its 501(c) (3) tax exempt approval letter from the IRS and return it to Equifax for the Company's matching gift. Equifax Community Affairs will process the returned forms, and send out checks to the recipient organizations. The employee will be notified that the match has been completed, or notified of any reason(s) the employee gift cannot be matched. No gift can be matched without a completed form clearly filled out by each party. Equifax reserves the exclusive right to determine the ultimate eligibility of all non-profit organizations.