Donation Request Form

All fields marked with * are required.

Donation Request

Contact Name *

Store Location *

Contact Phone Number *

Contact Email *

Address *

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)