DonationXchange - Request Form

Donation Request Form

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Organization Info
* Denotes required fields

* Organization:
501(c)(3) Federal E.I.N.:
* Type:

* Name of Benefit Fund:	(i.e. John Doe Benefit)
Partner Bank or Credit Union:	(partnering with benefit)

* 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:


Event Details
* Event Name:
* Description:
* Event Date:
* Event Location:
* Number of Guests:
Event Sponsor/Underwriter:

Request Details

* Item donated will be used for:

Live AuctionSilent AuctionRaffleOther

Please specify if other:

Attach a Document:

(You may attach documents that describes your event, your 501(c)(3) letter, or any other related document.
Click on Browse button to attach multiple documents - a maximum of three attachments will be saved. Limit the file size to less than 4MB.)


Referred By Name or Email: (if applicable)	(please enter the contact name or email of the person at this orgnization who referred you to submit your request. Leave blank if no one referred you)
Comments:


Address to where item should be mailed: Mailing address is same as aboveSpecify mailing address below
* Address:	(No PO boxes please)
* City:	State: Zip:
* Country:

*Please Note*
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 donation 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.