Donation Request Form
To be considered for a charitable donation, please complete the form below at least 7 days prior to your event.
Organization Information
Name of Organization
*
Street Address
*
City
*
State
*
Zip Code
*
Is your organization a non-profit or public tax-exempt organization as defined under Section 501(c)(3) of the Internal Revenue Code?
*
No
Yes
Tax ID#
*
Contact Information
Contact Person Name
*
First Name
Last Name
Contact Person Title
Contact Person Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Person E-Mail
*
example@example.com
Donation Request Details
Requested item(s) or amount
*
Anticipated number of participants
Date of event
*
-
Month
-
Day
Year
Date
Description of event
*
Specific benefits or outcomes expected from this donation
*
Date donation can be picked up at our office
-
Month
-
Day
Year
Date
Additional information for consideration
Office Use Only
Date Received
-
Month
-
Day
Year
Date
Approved
Yes
No
Donated Item(s)
Donated Value
Donation Received
Yes
No
Initials (Approval)
Initials (Donation Received)
Submit
Should be Empty: