Donation Request Form

* indicates a required field
* Type of Event:
* Date of Event:
Name of Event:
Title Sponsor of Event:
Organization/Event Web site:
Organization(s) Event Will Benefit:
Non-profit 501c3 number:
% of proceeds that go to charity?	%
How many participants are expected to attend?
How many spectators are expected to attend?
How did you hear about DOGSWELL®?
Has DOGSWELL® donated to you in the past?	yes no
Why would you like DOGSWELL® in particular to donate?
How will the event be promoted? Any press coverage?
How will DOGSWELL® be promoted?
Is there anything else you would like to tell us about your event/organization?
What would you like us to donate?
Gift basket:	Quantity
Samples:	Quantity
Donations arrive 1 week prior to event date, indicate if needed earlier:
* Name:
Company:
* Street address (no PO Boxes)
* City:
* State:
* ZIP code:
Phone number:
* Event contact name:
* Event contact E-mail:
* By submitting this donation request form, I hereby agree that any donation received is not to be used resale. All donations received from DOGSWELL® are for the use and organization noted above.	I agree