Charitable Contributions Request Form

Company/Organization Name*

My organization is a 501(c)3*

My organization provides services in the following counties*:

San Patricio Nueces Refugio Bee Live Oak Jim Wells Kleberg

First Name*

Last Name*

Email*

Phone*

Country region (Select one)*

Address Line 1*

Address Line 2

City*

State*

Zip Code*

My organization is requesting:

A monetary charitable donation Donation of items including canned goods, school supplies, household items, etc. Scholarship funding Sponsorship of a local event Other

Please tell us more about your request

Keep me updated with email notices!*

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Charitable contributions request form