BrittleBark

Donation Request

There are so many organizations that we have supported in the past and hope to be able to support in the future. However, due to the high volume of donation requests, we have defined our donation policy so that we can reach out to groups located in Central Pennsylvania; this includes Cumberland, Dauphin, York, and Perry Counties. Please do not send a letter or telephone us requesting a donation; we only accept donation requests through our website. We limit donations to 2 per month; please request early! Once we receive your request, we will contact you if we are able to provide a donation.

Please complete the following form to request a donation for 2010 (2009 is filled):

Name of Organization

Contact Person

Address

Phone Number

Fax Number

Email

Tax ID Number

This Organization is:
Educational
Arts
Culture
Charitable
Institutional

Date of Event:
Name of Event:

How will the donation be used:
Auction
Door Prize
Raffle
Other
(Explain)

Who do the proceeds benefit:

Did you receive a donation from us last year? Yes No

Are you a customer of Brittle Bark? Yes No

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