Donation Request - Legacy COOP

Name of Organization(Required)

Phone(Required)

Email(Required)

Donation Requested from Legacy (include amount):(Required)

Explain briefly how the donation will help your organization:(Required)

Has Legacy donated in the past? If yes, when and what was donated?

Is this organization associated with an employee of Legacy Coop? Who?

Do you need a Legacy Coop logo for advertising?(Required)

Yes

Date donation needed:(Required)

Request submitted by:(Required)

Address of Organization:(Required)

Street Address City State ZIP Code

Attachments

Drop files here or

Accepted file types: pdf, doc, Max. file size: 5 MB.

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