Charlotte Checkers Donation Request Form
Please fill out the form below and a Checkers representative will contact you within five business days.

*If you are filling out this request between December 20th and January 6th, please allow extra time for your request to be processed due to the holidays.
Name of organization requesting donation *
Your answer
Details of donation request (type of donation, event info, etc.) *
Your answer
EVENT DETAILS
Name of event *
Your answer
Date of event (must be in Checkers October - April regular season) *
MM
/
DD
/
YYYY
Time of event *
Time
:
CONTACT INFORMATION
Name *
Your answer
Phone *
Your answer
Email address *
Your answer
ADDRESS FOR DONATION TO BE SENT
Street address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
ADDITIONAL INFO
Have you done a group outing with the Checkers before? *
Would you be interested in doing a group outing with the Checkers in the future? *
Additional Event Information
Your answer
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