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Donation/Sponsorship Request
Name
*
Organization Name
*
Organization Tax ID #
Email Address
*
Phone
*
Address
*
Amount/Items Requested
*
Date donation is required by
+
Preferred payment method
*
Secondary payment method
*
How will this donation be used?
*
0/100 characters
Date of event
+
Are you a customer of Poka Lambro?
*
Yes
No
Has the organization received a donation from us previously?
*
Yes
No
Will specific mention be made of our support?
*
Yes
No
How?
*
0/100 characters
Any additional information you would like to provide.
0/100 characters
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