Gary's Donation Request Application

Please fill out this form to request a donation from Gary's Wine & Marketplace. For fundraising ideas, please check out our blog post here: https://garyswine.com/pages/raising-funds-with-garys-wine-and-marketplace

Organization Name

What is the name of your organization?

First Name

What is your first name?

Last Name

What is your last name?

What is your email address?

Phone Number

What is your phone number?

Is your organization located within 10 miles of a Gary's location?

Organization's City

What city is your organization located in?

Organization's State

What state is your organization located within?

Event Date

Enter the date of the event that you are raising money toward, if applicable

How can Gary's most effectively help support your organization?

Please select all that apply.

Please upload your organization's ST5 Certificate (if applicable).

(.pdf, .doc, .docx or .jpg file)

Attach file

Drop files here

Please upload your organization's tax exempt form (if applicable).

(.pdf, .doc, .docx or .jpg file)

Attach file

Drop files here

Please upload any additional documents relevant to your donation request.

Attach file

Drop files here

Please summarize your charitable organization's cause and how you plan to use this donation.

Donation sponsor

Please select Gary's Wine & Marketplace

Gary's Wine & Marketplace

Do not submit passwords through this form. Report malicious form