Donation Intent Form
Date:
MM
/
DD
/
YYYY
Organization Name (Donor Name): *
Your answer
Contact Name: *
Your answer
Contact Number: *
Your answer
Contact Email: *
Your answer
Mailing Address (for thank you notes):
Your answer
Would you like to be listed as a donor on our website? *
If the answer above is yes, then please send a logo to 12thcan.donation@gmail.com
How did you hear about the 12th Can? *
What kind of donor are you? *
Is this your first time donation to the 12th Can? *
By checking the boxes below, I agree with the following statements and authorize a 12th Can representative to contact me about setting up a donation time. *
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