Event Name----------------
Event Location-------------
Date of Event - mm dd yyyy-- ---
Time of Event ----------- - : AM PM
Event Beneficiary----------
Contact Name--------------
Phone Number-------------
Address---------------------
City--------------------------
State------------------------
Email------------------------
Fax Number----------------
Donation Request
Tax ID Number------
Are You A 501(c)(3) - Yes No
Comments
Donation Agreement
I agree that the information contained in this form is accurate. I understand that this is a request and I will not receive a donation from Terra Blanca Winery and Estate Vineyard until this request has been confirmed, processed and granted by Terra Blanca's Donation Committee. By submitting this request form, you are accepting this agreement.