Larenas Donation Request Form
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1DONATION REQUEST FORM
814-445-7773
1854 North Center Avenue
Somerset, PA 15501
General Policy
Larenas is committed to positively impacting the communities it serves by providing assistance to local schools,
churches, organizations and charities. We are happy to support your organizations fundraising endeavors
through the donation of gift certificates or product at our discretion. The following Donation Request Policy has
been developed as a way to create consistency and fairness to organizations that ask for Larenas support.
Since Larenas receives a number of requests, please be aware that we attempt to fulfill as many requests as
possible and cannot guarantee that every donation request will be met. Larenas places priority on giving to
qualified 501(C)3 charities.
Exclusions
Larenas is unable to honor requests or make contributions to the following:
•
Donations to labor, social or political groups.
•
Donations to benefit specific individuals or families.
•
Donations intended for online auctions.
•
Donations intended for resale.
•
Donations for monetary support.
Application
•
All donation requests must be submitted on Larenas “Donation Request Form” at least two weeks prior
to the event date. Form may be delivered via US Postal service or in person to above address.
ABOUT YOUR ORGANIZATION
•
The organization seeking the donation:____________________________________________
•
Is it a 501(c) 3? (Please submit a copy of the tax-exempt certificate.) yes no
•
What is your organizations mission? Please submit mission statement, and other paper work supporting
your mission and/or website address:________________________________
•
Has it received a donation from Larenas in the past?
Yes
No
•
Your relationship to the organization:______________________________________________
•
Organization’s President:__________________________________________________
ABOUT THE DONATION
•
The name and type of event at which the donation will be used:_________________________
•
The event’s goal:_____________________________________________________________
•
What will the donation be used for?
auction item
prize item
Other:_______________________________________________________________________
•
The exact donation you are seeking:_______________________________________________
•
Recognition to donors (at the event, prior, subsequent, etc.):____________________________
LOGISTICS BASICS
We will provide specific information as to where donated product will be available for pick-up.
1. Date needed:______________________________
2.Time needed:______________________
3. Who will pick it up?_________________________
4. Person’s work/home phones:_______________________________________________________
Printed Name of Person making request
Signature of Person making request
Date
FOR OUR USE, PLEASE
Date Rec’d
Approved or
Date of Reply
Decision made by
QB Entry Date TOTAL COGS
Declined?
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