Donation Request Form

Asterisk indicates Required Field
  • First Name
    *
  • Last Name
    *
  • Email
    *
  • Phone
    *
  • Address
    *
  • City
    *
  • State
    *
  • Zip Code
    *
  • Organization Name
    *
  • Make check payable to
    *
  • Purpose of Organization
    *
  • Length of organization's existence in years
    *
  • Is this donation associated with an event such as a dinner or run/walk?
    *
  • What is the purpose of this event and who will benefit from it?
    *
  • What is the projected dollar goal of this event?
    *
  • What percentage of proceeds will be used for administration?
    *
  • Decision needed by:
    *
  • What would you like us to donate?
    *
  • Specifically, how will this donated product/money be used?
    *
  • Have you or your organization made a request from Bodensteiner Implement in the last 12 months? If yes, please explain
    *
  • When will this event take place?
    *
  • Is this Organization a non-profit (501c)?
    *
  • Attachment Upload (not required)
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