DONATION REQUEST FORM
ORGANIZATION INFORMATION
ORGANIZATION NAME
*
ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
TELEPHONE NUMBER
*
Please enter a valid phone number.
Format: (000) 000-0000.
ORGANIZATION WEBSITE
NAME OF CONTACT
*
First Name
Last Name
TITLE OR RELATIONSHIP TO ORGANIZATION
*
CONTACT'S TELEPHONE NUMBER
*
Please enter a valid phone number.
Format: (000) 000-0000.
CONTACT'S EMAIL ADDRESS
*
example@example.com
WOULD IT BE OK FOR US TO CORRESPOND WITH YOU VIA EMAIL?
*
Yes
No
MAY WE USE SMS TO COMMUNICATE WITH YOU? WE MAY USE SMS AUTOMATION TO COMMUNICATE REGARDING YOUR DONATION REQUEST. NO PURCHASE IS NECESSARY. YOU CAN OPT OUT AT ANY TIME BY REPLYING "END" OR "STOP" TO ANY MESSAGE WE SEND.
*
Yes
No
IS YOUR ORGANIZATION A 501(C)(3) NONPROFIT?
*
Yes
No
IF YOU ANSWERED "YES" ABOVE, PLEASE UPLOAD A COPY OF YOUR IRS 501(C)(3) DETERMINATION LETTER BELOW.
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EVENT INFORMATION
NAME OF EVENT/INITIATVE
*
DATE OF EVENT
*
EVENT LOCATION
BRIEF DESCRIPTION OF EVENT OR CAUSE
*
ESTIMATED EVENT ATTENDANCE OR REACH
DONATION REQUEST DETAILS
TYPE OF DONATION REQUESTED
*
Gift Card
Gift Basket & Gift Card
Monetary Donation
Other
ARE YOU A CUSTOMER OF ROXI & CO?
Yes
No
HAS ROXI & CO DONATED TO YOUR ORGANIZATION IN THE PAST?
Yes
No
HOW WILL ROXI & CO BE RECOGNIZED AT THE EVENT OR IN PROMOTIONAL MATERIALS?
PURPOSE & IMPACT
HOW WILL THIS DONATION BENEFIT YOUR ORGANIZATION AND/OR THE COMMUNITY?
*
IS THIS EVENT OR CAUSE PET-RELATED OR SUPPORTING ANIMAL WELFARE?
*
Yes
No
HOW WILL THE DONATION HELP YOU ORGANIZATION ACHIEVE ITS GOALS?
SUBMISSION CONFIRMATION
IS THERE ANYTHING ELSE YOU'D LIKE US TO KNOW ABOUT YOUR DONATION REQUEST?
I CONFIRM THIS REQUEST IS BEING SUBMITTED AT LEAST 4 WEEKS BEFORE EVENT OR DEADLINE.
*
Yes
SUBMIT
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