Donation Request Form

* = Required Field

• Request Information

• Date of Request
• Date of Event/Project
• Agency Name*
• Location Address
• Zip
• City
• State -- Select A State -- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
• Mailing Address
• Phone*
• Fax
• Email*
• Contact Person
• Title
• VGM Employee Sponsor (if applicable)

• Have you received funding from the VGM Group?

• VGM Group:

  Yes
  No

• If yes, what type of support have you received? Please provide dates, amounts, and types of support.

• VGM:

• Does your agency have a website?

• Yes
  No

• If yes, please provide address:

• Is this an annual event/program?

• Yes
  No
• Amount of Request*
  $

• Upload Request Forms

  Acceptable Files: pdf, doc, docx, txt