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Donation Request

You can fill out the information below, or you can download the donation dequest here
and send it to us in the mail.

( * denotes a required field. )
* Today's Date:
* Applicant's Name:
* Phone #:
* Non-Profit/Group:
* Email:
* Address:
* Group's Purpose:
* Tax ID #:
* Event/Project:
* Event Beneficiary:
* Donation Needed By:
* Date & Time of Event:
* Location of Event:
* Number of People Expected:
* Type of Recognition for Donators:
* Requesting Donation of (Choose One):
 Money Material Other
If Other:
* Requested Amount:
* Human Check:
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