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Donation Request Form

We have many requests for donations...from some of the most considerate organizations in Maine doing great work...and would like to participate in all of them, however, like all companies our budget only goes so far.  Please complete the information below and we promise to take a close look, give it serious consideration and provide a response as soon as possible. 

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Contact Name & Title: *
E-mail: *
Phone Number: *
Organization Name: *
Organization Type *
OTHER(specify here)
Organization Structure: *
Description/Mission/Event: *
Event Date:
Select Day of Week:
Event Time:
 : 
Donation Method: *
Donation Amount: *
Human Verification: