Donation Request

Donation Request

Organization Information

Legal Organization Name*

Are you a public charity?*

Yes

Tax Status*

Address*

Address Line 2

City*

State / Province / Region*

Postal / Zip Code*

Country*

United States

Description of the Organization*

Organization Website

First Name*

Last Name*

Phone Number*

Please use Berkot's Rewards number if applicable.

Phone

Loyalty #

Use this field if different than number above.

Phone

Email*

What is the name of this project?*

Description of project this donation will support*

Estimated Number of Attendees*

Date of Event*

Request Amount or Type of Donation*

How will sponsors be recognized?*

Additional Comments

Closest Berkot's Location to Your Event or Charity*

Select

Attach Any Extra Info (Flyers, Etc.) When Submitting

Drag and drop files here or