General Donation Request Form

Organization Name *

Contact Name *

Phone *

Email *

Ideal Pickup Date *

Please leave at least 10 days

Name of Event/Campaign (If Applicable)

Date of Event/Campaign (If Applicable)

Estimated Event/Campaign Reach (if applicable)

How many people do you expect at your event?

Please choose one of the following: *

Gift Card worth $50

Gift Basket worth $75

We would be happy with any of the above.

What will this donation be used for? *

How will this benefit the community? *

Are you being funded for this project from other sources? *

Yes

No

Maybe

OtherOther

If yes, from where?

General Donation Form