IN-KIND DONATIONS

Cacti Park of the Palm Beaches is committed to enhancing the

quality of life for citizens in the Palm Beaches

Donation Request Form

Organization Info

*Denotes required fields

Organization Country:

TAX ID:

Zip:

Organization Name:

Organization Type:

Name:

(i.e. CEO, President, Executive Director, or Development Officer at the Organization)

First Name

Last Name

Address:

(No PO boxes please)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Email:

Primary Phone:

Country

(###)

###

####

Mission Statement:

Website:

http://

REQUESTER CONTACT INFORMATION

Requester Name:

First Name

Last Name

Requester Email:

Requester Phone:

Country

(###)

###

####

Cell/Other Phone:

Country

(###)

###

####

Title/Relationship to Organization:

ORGANIZATION'S EVENT DETAILS

Event Name:

Event Description:

(Please enter an event description that is not specific to this donor or donation request. You may use the comments below for additional details)

Event Date:

YYYY

Event Location:

Number of Guests:

Event Sponsor/Underwriter:

(If no event sponsor/underwriter, please enter N/A)

Donation Request

Donation Request Description

(if no additional description needed, please enter N/A)

Item donated will be used for:

Certified 501(c)(3) and Additional Information to Describe the Event:

Please provide your Employer Identification Number, Public Charity Status, Director, Exempt Organizations First and Last Name, and any additional information related to your event) *A copy of your 501(c)(3) document (Not Tax-Exempt form) and additional documents describing your event are required to be sent to info@ballparkpalmbeaches.com (Subject: 501(c)(3) document and Organization) upon completion of this form.

Referred By:

(Please enter the contact name of the person at this organization who requested you to submit your request. Leave blank if no one referred you)

Comments:

Address to where item should be mailed:

(If possible, please provide a commercial mailing address)

Mailing address is same as above

Specify mailing address below

Specified Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I would like to receive commercial emails from CACTIPark.com

Yes

*Please Note*

submission of this request does not guarantee that your request will be fulfilled. This request system has been implemented to decrease our carbon footprint and to help protect our environment. We appreciate your support. Thank you.

I confirm that I am 14 years or older

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Donation Request Form

CACTI Park of The Palm Beaches

5444 Haverhill Road, West Palm Beach, Florida 33407

561.500.HITS (4487) • Info@CACTIPark.com