Donation Request Form

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Donation Request Form
Date: ____/____/______
Organization Name: _____________________________________________________________
Organization URL: _______________________________________________________________
Address: ______________________________________________________________________
City: _______________________________________ State: __________ Zip: _______________
Contact Name: _________________________________________________________________
Contact Title: __________________________________________________________________
Contact Email: __________________________________________________________________
Contact Phone: _________________________________________________________________
Description of services provided and community served:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Name and Description of Event or Activity:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Date of Activity: ____/____/______ through ____/____/______
Anticipated Number of Participants: ______________________
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