Name of Organization
*
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Date of Event
*
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Month
/
Day
Year
Date
Name of Event
*
Location of Event
*
What would you like us to donate?
*
Event Description
*
(i.e. time, number of people attending, purpose)
How will the donation be used?
*
Auction
Raffle
Door Prize
Other
Is this event a fundraiser
*
Yes
No
Who do the proceeds benefit?
*
How will Gillman Home Center's Donation be recognized?
*
Have you received a donation from us before?
*
Yes
No
What is your deadline for receiving the donation?
*
/
Month
/
Day
Year
Date
Please specify which store(s) to direct your request to
*
Batesville
Brookville
Connersville
Oxford
Edinburgh
Centerville
Winchester
New Castle
Eaton
Aurora
Frankfort
Lebanon
Gas City
Hartford City
Muncie
Shelbyville
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