Donation Request 2016 - Dutch Bros. Coffee

Donation Request Form

All requests must be submitted at least 30 days prior to your event. Dutch Bros Coffee does not give monetary donations; however, we accept requests for product related donations.

Contact Information:

Today's Date: Organization: Contact Name: Address: City: Phone:

State: Email:

501c3 Tax ID #:

Zip:

Request Details: Donation request:

Has Dutch Bros supported you in the past?

Please explain exactly what you are requesting of Dutch Bros Coffee:

If Event ? Date(s) & Time of the Event:

Event Name/Description:

Event Location (address):

What/Who will the event benefit? Date Donation is Needed:

Yes

No

Additional Notes:

Please drop off completed form to the Dutch Bros location nearest to your request/event.

14-2923A

For office use only. Approved Denied

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