Donation Request Form GDD

Donation Request Form

GDD Pharmacy Services Inc.
To be considered for a charitable donation for your organization located in the neighborhood of one of the pharmacies in our group, please complete the form below.

Our family of independent pharmacist owned pharmacies: Harrisburg Pharmacy, Good Day Pharmacy, See-Right Pharmacy, Pine Grove Pharmacy, Cumberland Apothecary.
Organization (If applicable)
Street address:
Street address line 2:
City:
State:
Zip code:
Contact Person
First name:*
Last name:*
Phone number:*
Please include area code
Email:*
Best time to reach you?

MorningAfternoonEveningAnytime
What is the best way to reach you?*

EmailTelephoneEither
Do you know someone in our company personally?

NoYes
If yes, Who?
Do you do business with us?

YesNo
If Yes, at which pharmacy?

Harrisburg PharmacySee-Right PharmacyGood Day PharmacyCumberland ApothecaryPine grove Pharmacy
Have you applied for a donation for your organization in the past?

YesNo
Federal tax exempt 501c public charity?
Requested Amount
Or, request an item donation
What would be good?
Or, tell us how we may help you another way....
Description of need
When/Where will the event take place?
(If Applicable)
When do you need to receive the donation?

MonthDayYear
What specific benefits/outcomes will be realized with this donation?
Would you be willing to provide photos or a short note if available regarding the outcome of for use on our social media and to share with our employees?

YesNo
Please verify that you are human*
Should be Empty: