Donation Request Form
If you support an association that needs donation or you lead efforts of an association, please fill out the Application Form and send it back to us, we will consider your application as best we can.
Date Donation Required
MM
/
DD
/
YYYY
Organization Requesting Donation:
Your answer
Address
Your answer
City
Your answer
Country
Your answer
State
Your answer
Zip
Your answer
Org. Phone
Your answer
Org. Fax
Your answer
Website
Your answer
Contact Person
Your answer
Contact Person Email
Your answer
Are you a Hops & Vines Customer?
Org tax exempt under IRS Code Sect 501(C)3?, Number :
Your answer
What is the mission statement of the organization?
Your answer
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