Donation Request Form


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Organization Info
* Denotes required fields
* Organization:
501(c)(3) Federal E.I.N.:
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Year Established:
* Organization Type:
* Name of Benefit Fund:
(i.e. John Doe Benefit)
Partner Bank or Credit Union:
(partnering with benefit)
* First Name:   Last Name:
(i.e. CEO, President, Executive Director, or Development Officer at the Organization)
* Street:
(No PO boxes please)
* City:  State:   Zip:
* Country:
* Primary Email:
* Primary Phone:
Website:
Requester Contact Information
* First Name:   Last Name:
* Email Address:
* Primary Phone:
 Cell/Other Phone:
 Title/Relationship to Organization:
Organization's Event Details
* Event Name:
* Description:
* Event Date:
* Event Location:
* Number of Guests:
* Event Sponsor/Underwriter:
(if no event sponsor/underwriter, please write N/A)
Request Details
* Item donated will be used for:


Referred By:
(if applicable)
(Please enter the contact name of the person at this organization who referred you to submit your request. Leave blank if no one referred you)
Comments:
Address to where item should be mailed (If possible, please provide a commercial mailing address):
* Address: (No PO boxes please)
* City:   State:   Zip:
* Country:

*Please Note*
Submission of this request does not guarantee that your request will be fulfilled.
To review the status of your request at any time, please login with your user name and password, which will be emailed to you shortly; status requests will not be received over the telephone.
This request system has been implemented to decrease our carbon footprint and to help protect our environment. We appreciate your support with all new procedures and policies. Thank you.
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