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Request for Donation
Please note: Requests must be made at least three weeks in advance of the event date in order to be eligible for a donation.
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* Indicates required question
Title of Event or Fundraiser
*
Your answer
Name of Organization
*
Your answer
Contact Name
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Description/Purpose of Event
*
Your answer
Items Requested
*
Containers of Brewed Coffee (Higher Grounds Brews)
Packaged Coffee to Serve at Event (Event Holder Brews)
12oz Bags Of Coffee
Gift Basket
Gift Certificate
Other:
Quantity of Item Requested
Brewed Coffee or Packaged Coffee to Serve: How many people will you be serving? // 12oz Bags, Gift Basket, or Gift Certificate: How many are you requesting?
Your answer
Date of Event/Fundraiser
*
MM
/
DD
/
YYYY
Time
:
AM
PM
How will this donation be acknowledged?
*
i.e. display and/or distribution of HG promo materials, signs, ect
Your answer
If your donation is approved, when would you like to pick it up?
*
Please note: Requests must be made at least three weeks in advance of the event date in order to be eligible for a donation.
MM
/
DD
/
YYYY
Time
:
AM
PM
Comments & Any other Relevant Details
Your answer
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