Donation

Donation Request

Today's Date

Requesting Organization

First Name

Last Name

Email Address

Location

Mailing Address

Address Line 1

Address Line 2

City

State

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Flo's Location

Tax ID#

Is the donation for a non-profit organization? (If yes, please provide your IRS designation as a 501 (C)(3) non-profit organization) *

Yes

Is this donation in association with a particular event?

Yes

If yes, when is the event?

Name of the event and a brief description or attach the event information

What kind of donation or charitable gift are you looking for?

Any additional comments, directions or details we may need to know

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