Donation Request Form

* = Required Field

• Date of Request*
• Date of Event/Project

• Requestor (Your) Contact Information

• Name*
• Email*
• Phone*

• Organization Information

• Name*
• Contact Person*
• Contact Title
• Contact Email*
• Contact Phone Number*
• Organization Fax Number
• Event 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
• Organization Mailing 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
• Is your organization a designated non-profit?*
  Non-profit:

  Yes
  No
  If yes, please provide a copy of your W-9 form (2018 or newer version) in the Upload Request Forms section.
• VGM Employee Sponsor (if applicable)

• Request Information

• Have you received previous 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 organization have a website?* Yes
  No
• If yes, please provide address:
• Is this an annual event/program?* Yes
  No
• Amount of Request*
  $
• Please provide a brief overview of your request and what the funds would benefit.*

• Upload Request Forms

  Acceptable Files: pdf, doc, docx, txt