Neighbors Helping Neighbors Donation Request

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NHN Donation Request

Recipient is an *

Is this donation associated with an event (Charity dinner, run/walk, etc.) *

Is the recipient a Kwik Trip co-worker?

If the recipient of the request is a Kwik Trip co-worker, please contact the Families Helping Families hotline: 608-793-6343.

Contact Name (First and Last) *

Contact Phone *

Contact Email *

Organization Name *

Purpose of Organization *

How long has your organization existed? *

Month/Years *

Street Address *

City *

State *

Zip Code *

What percent of the proceeds will be used for administration? (e.g. 10%) *

Event Name *

Date of Event *

Event Address *

Purpose of Event / Who benefits? *

Recipient Name (First and Last) *

Recipient Street Address *

Recipient City *

Recipient State *

Recipient Zip Code *

Donation Preference: *

Product and quantity or monetary amount requested: *

How will this donation be used? *

Limit response to 500 characters.

Decision needed by

If you are human, leave this field blank.