Local Donation Request Form

Charitable Organization Name

Contact Name

Phone

(area code included)

Confirm email

Address

Address 2

City

State

ZIP

What is the purpose of the event or campaign?

What would you like DLO to contribute?

(Money, Goods, Services, etc.)

If the request is for Goods or Services, describe the requested product(s)

Is the charity or foundation a current or potential customer of DLO?

Does the charity or foundation have an IRS Regulation 501(c)(3) status?

Have you sought contributions broadly from the community for the campaign/event?

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