Donation Request

    1. ORGANIZATION INFORMATION

    Organization/Group Name *

    Contact Person & Title *

    Phone *

    Email *

    Mailing Address *

    EIN/Tax ID (if applicable)

    Organization Type *

    2. EVENT OR PROGRAM DETAILS

    Event/Program Name *

    Event Date(s) *

    Event Location *

    Expected Attendance *

    Briefly describe the event and how funds/donated items will be used *

    3. REQUEST DETAILS

    Type of Donation Requested (select all that apply) *

    Specific Item Requested or Dollar Amount

    Date Needed By *

    Will Southern Cart be recognized in any signage or social media?

    4. REQUESTOR SIGNATURE

    Name *