Donate

Cheek and Scott is proud to be a locally owned and operated Community Pharmacy and Medical Equipment provider for our area. We appreciate the opportunities to support our community by considering a contribution to your Organization. Due to the high volume of requests for contributions, we ask that you complete the form below so that we can consider your inquiry.

Full Name

First NameLast Name

E-mail

Name of Organization:

(if funded, the check will be made to this organization)

Organization is incorporated as a 501(c)(3) non-profit?

Federal Tax ID #:

Your title / position at Organization:

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Organization's Website:

Organization's Facebook page:

Description of Organization:

Select a category that this Sponsorship / Donation would fall under:

Name of Project or Event

Date of Project or Event

MonthDayYear

Project or Event Description:

Project or Event flyer, brochure, informational sheet, etc. (PDF format preferred):

Upload a File

How many people do you anticipate attending this event?

Which C&S Store does this pertain to?

Amount or Item(s) Requested:

Has Cheek and Scott contributed to your Organization's project or event previously? If so, how much was our contribution before?

Will this contribution primarily benefit low- to moderate-income individuals? If YES, please explain:

Please list all advertising opportunities associated with this project/event which will be available to Cheek & Scott (should we decide to help fund this project/event)

Please explain any other advertising and promotional opportunities:

Deadline for advertising opportunity:

MonthDayYear

Do you and/or your Organization consider Cheek & Scott as their primary pharmacy? If not, what would be instrumental for you to allow us to serve your pharmacy and medical equipment needs?