Jordan's Furniture Charity Request Form

All donations are to be mailed to an organization's office address (and not a residential home), per process. Please provide a complete address, including contact person.

* All fields are required.

Organization Information

Organization Information

Organization Name
Street Address
City
States Zip Code
Web Address
Tax ID Number
Year Established
Organization
Mission Statement

Contact Information

Contact Information

First Name
Last Name
Title
Phone Number
Email Address
Email Address (confirmed)

Donation Request Information

Donation Request Information

Donation Needed By: (MM/DD/YYYY)

Donation Needed for:
Fiscal Support of Organization

Amount Requested
Specific Program Support

Amount Requested
Event/Fundraiser Sponsorship

Amount Requested
Gift Card

Dollar Amount Requested
Ticket to IMAX

Number of Tickets Required
Other (Please explain)
Additional Comment
Due to the high volume of requests only fully completed applications will be reviewed. Please allow three weeks for a response. Thank you for your patience.
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