Donation Request Form

Thank you for your interest in Wickersham Jewelry as a prospective contributor to your organization. To be considered, please fill out the form below. A Wickersham representative will be in contact with you shortly.

Items marked with an asterisk (*) are required.

Your Information
* Current Customer	Yes No
* Contact Name
* Contact City
* Contact State
* Contact Zip
* Phone Number
* Email Address
About Your Organization
* Organization Name
* Organization Address
* Organization City
* Organization State
* Organization Zip
Non-Profit Tax ID
Website
* Your organizations mission
Has your organization received a donation from us in the past?
About the Donation
* Name and type of event at which the donation will be used
* Event Date
* Approximate number of people attending
* Goal of the event
Approximately what percentage of the event's proceeds will go towards the cause?
* What will the donation be used for? (e.g., auction item, raffle, etc...)
* Type of donation (item) requested
Would the donation involve a display or signage? If so, please describe.
* Will Wickersham Jewelry be the exclusive jeweler for this event?
Anything else you would like us to know?
Pickup Information Please provide the following information. If your donation is approved, we will need to know how you wish to pick the item up.
Pickup Date
Name of person picking item up
Phone number of person picking item up