Donation Request Form

Asterisk indicates Required Field

Organization Name
Today's Date
Address
City
State
Zip Code
Contact Person:
First Name

*
Last Name

*
Job Title

Phone
Ext
Phone 2
Ext
Fax
Email

*

Tax Exempt#

(Please provide if you obtain a 501-C3.)
Brief Description of the Event
Date of Event
Location of Event
Items Requested:
Monetary $
Sponsorship $
Merchandise
Other
How will this/these item(s) be used?
Have you requested donations from us in the past?

Yes No
Date Requested

When is donation needed?
Amount expected to be raised $
What programs/services does your organization offer?
Generally, we cannot provide delivery of donated goods. Can your organization arrange for pick-up?

Yes No
If so, who is authorized for pick-up?

An officer of the organization’s governing body must sign this application:
The undersigned, an authorized officer of the organization, does hereby certify that the information set forth in this application is true and correct, that the Federal Tax Exemption determination letter attached hereto has not been revoked and the present operation of the organization and its current sources of support are not inconsistent with the organization’s continuing tax exempt classification as set forth in such determination letter.

Donation Request Form

Contact Person:

Items Requested: