Donation Request Thank you for considering Wine Road for inclusion in your fundraising event. At this time we cannot fulfill ANY requests for events taking place prior to September 2019. Please do not fill out and submit the request if your event is prior to September. We are passionate about supporting our local community and where budget permits we’ll extend our giving to causes outside our area. We have already fulfilled to over 200 requests in 2019. We ask that you fill out the information below, rather than mail us a request. Please understand that we receive a large number of requests and cannot honor all of them. Requests must be made at least eight (8) weeks prior to your event. You will be contacted via email informing you if we can fulfill your request or not. Donations are subject to availability and are not redeemable for cash. Wine Road does not make cash donations. Completing this form does not guarantee your request will be honored. Thank you for your understanding. Organization InformationName of Organization*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone #*FaxWebsite Tax ID*Requesting Individual’s InformationYour Name*Your TitleEmail* Phone #*Donation InformationDate of Event*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date Donation Required by*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Event NameDescription of EventOther important info we should knowCommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
