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?
What is the best way to reach you?
Do you know someone in our company personally?
If yes, Who?
Do you do business with us?
If Yes, at which pharmacy?
Have you applied for a donation for your organization in the past?
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?
Please verify that you are human
Should be Empty: