Date Request Submitted

Date of Event

Name of Organization

Address

Email Address

Is the Organization Non-Profit? Is the Organization Non-Profit? Yes No

If Yes, Tax ID#

Name of Event

Contact Person

Phone Number

What service does your organization provide for the community?

Please provide a brief description of the reason for the request and how it will be utilized.

Please list the item(s) you would like us to consider donating: