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: *
Address *
City *
Country *
State *
Zip *
Org. Phone *
Org. Fax
Website
Contact Person *
Contact Person Email *
Are you a Hops & Vines Customer? *
Org tax exempt under IRS Code Sect 501(C)3?, Number :
What is the mission statement of the organization? *
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