Basket Donation Submission Form

1

Thank you for your interest in donating a basket to our fundraising event!

When you donate a basket, we will do a Facebook™ and Instagram shout-out unless you elect us not to do so.

We will add your business name to our Supporter's website page if you are a business entity.

We will add your name to our Supporter's website page if you are not a business entity.

You will be contacted by our volunteers to coordinate the basket donation when a fundraising event is coming up.

The charities that you will be helping appreciate your support, as do we!

2

Contact Name* This field is required.This is who we will contact

First Name

Last Name

3

Contact Phone Number* This field is required.This is the phone number we will use to contact you

Please enter a valid phone number.

4

Contact Email* This field is required.This is the email we will use to contact you. By submitting your email, you herby agree to receive future basket donation email notifications from the New Port Richey Elks Lodge 2284. We do not spam and we do not sell your information.

example@example.com

5

Will The Basket Donation Be On Behalf Of a Business?* This field is required.You wish to have your business donate the basket

YESNO

6

Name of Business You Wish DisplayedExample: Pineapple Placement Senior Living Advisors

7

Business Facebook Page URLExample: https://www.facebook.com/NewPortRicheyElksLodge2284

8

Business Instagram Page URLExample: https://www.instagram.com/newportricheyelks/

9

Do You Want Us To A Facebook or Instagram Shout-Out Using Your Name?

YESNO

10

Please Enter Your Facebook Profile URLIf you have one. If you do not leave blank

11

Please Enter Your Instagram Profile URLIf you have one. If you do not leave blank

12

Basket Item Information. Please give a detailed description of the donated item(s) and their contents. Include all applicable restrictions. Gift Certificates should be valid for 6 months after the fundraising event date* This field is required.

13

Value of Basket Item: (minimum $25)* This field is required.