Donation Request Form

Organization Info
* Denotes required fields
* Organization Country:
* Tax ID :   Zip:
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* Organization Name:
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:
* Primary Email:
* Primary Phone:
* Mission Statement:

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:
(Please enter an event description that is not specific to this donor or donation request. You may use the comments below for additional details)
* Event Date:
* Event Location:
* Number of Guests:
* Event Sponsor/Underwriter:
(if no event sponsor/underwriter, please enter N/A)

Request Details
* Item donated will be used for:

Attach a Document:

Please attach the following documents:
• Certified 501(c)(3) document (Not Tax-Exempt form)
• Documents that describe your event, or any other related document.

(Click on Browse button to attach multiple documents. 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 4MB.)

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.

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 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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