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Donation Request Form

Step 1. Organization Information


Denotes required fields *
Organization Country *:
Category *:
Tax ID * :   Postal Code:
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Organization Legal Name *:
Doing Business As (DBA) :
Prior or Alternate Legal Names:
Year Established:
Organization Type * :
Name of Benefit Fund *:
(i.e. John Doe Benefit)
Partner Bank or Credit Union:
(partnering with benefit)
Organization Contact:
First Name *:   Last Name:
Title *:
Physical Address *:
(No PO boxes Permitted)
City *:  State:
Primary Email *:
Primary Phone *:
Mission Statement *:
Website:
Principal Individuals
and Board Members :
(enter a minimum of 3)

Step 2. Primary Contact Information

First Name *:   Last Name:
Email Address *:
(this will be in the email used to communicate the status of the request moving forward. please verify the email)
Primary Phone *:
Cell/Other Phone:
Title/Relationship to Organization *:

Step 3. Request Information


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 *:



Attach a Document:
Select
You may attach documents that describe your event, your 501(c)(3) letter, or any other related document.

(Click on Select button to attach multiple documents. The files should be selected from a folder on your computer. The files will be listed under the attachment box. Files will be uploaded when you click submit. A maximum of three attachments will be saved. Attachments must be in one (1) of the following formats: Pdf, doc, docx, xls, xlsx. Limit the file size to less than 10MB.)

Referred By:
(if applicable)

Please enter the contact name of the person at this organization who requested you to submit your request. Leave blank if no one referred you.
Comments:

 
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*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 of 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. Thank you.
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