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Donation Request
Part of our mission at The Barley House is to give back to our local community, which is the backbone of our success. If you would like The Barley House to donate a gift card to your New Hampshire organization or special cause, please fill out our request form. (Note: The Barley House does not donate cash)

• All gift card donations must be picked up at The Barley House location that you are contacting.
• All request must be made 2 weeks in advance of event.
• The Barley House will donate up to 2 – $15 gift cards depending upon the request.

Email address
Name
First and last name
Your answer
Phone number
Your answer
Organization / Company
Your answer
Address
Your answer
City / State / Zip Code
Your answer
If your organization is a non-profit, please provide Tax I.D.
Your answer
Describe event
Your answer
Date of event
MM
/
DD
/
YYYY
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