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CANUS FOR A CURE DONATION REQUEST FORM
(*) = Required Field
Please fill out the information below for us to consider your request
Organization Name: (*)
Please enter your organization's name!
Organization Address: (Street, City, Zip) (*)
Please enter your organization's address!
Contact Name: (*)
Please enter your contact's name!
Email Address: (*)
Please enter a correct email address!
Event Name: (*)
Please enter your event name!
Date of Event: (*)
Please enter your event's date!
Location of Event: (*)
Please enter your event's location!
# of People Attending: (*)
Please enter the number of people attending your event!
Event Type: Please choose one (*)
Komen Race for the Cure™ Event
Other Cancer-related Cause or Event
Please choose your Event Type
Other Cancer-related Cause or Event Type (please describe):
How will this donation benefit your organization/event?
Has your organization received donations from Canus in the past? (*)
If you replied, "Yes" to the above question, for what Event name?
Type of Product Requested: (*)
Goat's Milk Soap Bars
Please choose a donation type!
Product Quantity (How much do you need?) (*)
Is your organization a 501C-3?
Please fax non-profit status certificate to Robin at Canus VT, 802-244-7343
Ship To Address: (no PO Boxes allowed. Please note we can only ship to business addresses). Please indicate any special shipping instructions:
Can this address accept pallet deliveries: (*)
Please tell us if you can accept palette deliveries
If No, please provide an additional business "Ship To" address that has a loading dock and can accept a pallet
Date needed to arrive by: (*)
Please enter a date
Additional Event Information:
Canus will review all requests and notify you of our decision. If you have any questions or concerns, please contact Lisa Lazarczyk at 781-646-0667 or firstname.lastname@example.org. THANK YOU!
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