Adam Puchta Winery Donation Request Form
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1Donation Request Form
Adam Puchta Winery is a small, family-owned winery that is committed to giving back to the communities we serve. However, due to the
high number of donation requests we receive we are not able to commit to every request. The winery has chosen to focus its efforts on local
fundraisers.
Thank you for considering Adam Puchta Winery for participation in your upcoming fundraising event. We wish you the best of luck in your
efforts.
EVENT DATE: ________________________________________________________________________________________________________
HOSTING ORGANIZATION: ____________________________________________________________________________________________
CONTACT PERSON: __________________________________________________________________________________________________
PHONE:_____________________________________________________ FAX: _________________________________________________
EMAIL ADDRESS: ____________________________________________________________________________________________________
MAILING ADDRESS: __________________________________________________________________________________________________
CITY: ___________________________________________________ STATE: ___________________________ ZIP: _____________________
EVENT NAME: ______________________________________________ EVENT LOCATION: _________________________________________
ESTIMATED NUMBER OF ATTENDEES: ___________________________________________________________________________________
EVENT DESCRIPTION (the cause, who benefits, etc...): _______________________________________________________________________
___________________________________________________________________________________________________________________
ITEMS TO BE USED FOR (silent auction, live auction, bar service, raffles, etc...): __________________________________________________
___________________________________________________________________________________________________________________
Please return the completed form and any additional information about the fundraiser (i.e. flyer, letter, etc...) to:
Adam Puchta Winery
Attention: Donations
1947 Frene Creek Road, Hermann, MO 65041
Email:
Fax: 573-486-2361
Due to the volume of donation request received it's not always possible to respond to follow up correspondence.
We will contact you if we are able to fill your donation request.
OFFICE USE ONLY
DATE RECEIVED: ______________________________________________ DONATION REQUEST FILLED:
YES
NO
DONATED ITEM (wine, gift basket, certificates, special event etc...): ______________________________________________
(Complete an itemized list of donation and attach to this form)
DONATION VALUE: _____________________________________________________________________________________
DATE CALLED & INITIALS: ____________________________________________ PREPARED BY: _______________________
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