Donation Request
Fill out this form to request donations from Adopt-A-Block Inc. Please allow 30 business days for a response. Call 410-665-5595 or email daniel@acancan.com to check on the status of your request. Your primary contact will be called and emailed upon request approval.
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Organization name: *
Organization address: *
Primary contact first and last name: *
Primary contact title: *
Primary contact phone number: *
Primary contact email address: *
Please describe your organization below: *
Are you an A Can-Can Make A Difference Partner? *
Enter your Employer Identification Number (EIN)
What is the name of the event you are requesting donations for? *
Date of your event: *
MM
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YYYY
Time of your event: *
Time
:
Location of your event: *
What donations are you requesting? Please be descriptive and include quantities, colors, and/or sizes etc. *
How will these donations be used? *
How many people will benefit from these donation? *
What age range will these donations benefit? Check all that apply. *
Required
We love to serve! Do you need volunteers for your event? *
If yes, how many additional volunteers do you need for your event? *
How will Adopt-A-Block Inc. or A Can-Can Make A Difference be mentioned or represented as a sponsor at your event? Enter "N/A" if we will not be mentioned or represented at your event. *
How did you hear about our program? *
Anything else we should know or you would like to share?
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