Outreach Request Form - Pizza Gallery & Grill

We believe in “Enriching Our Community” and want to recognize what you and your organization are doing in Brevard County. We know there are many worthy charities and causes that depend on contributions to continue their amazing work. Please understand that our resources are limited and that we will do our very best to honor your request. We ask these questions: A. Is your organization nonprofit? B. Does your organization “Enrich Our Community”? C. Is this a local organization? Thank you for reading and filling out this request form. We appreciate your time, it will help us to make an informed decision!

Name*

First Last

Date*

Your Phone

Date of Event*

Your Email*

Your Organization

The organization seeking the donation:*

Is it a 501(c)3?(Please submit a copy of the tax-exempt certificate.)*

Tax-Except Certificate

Max. file size: 50 MB.

What is your organization's mission? Please submit mission statement, most recent correspondence to stakeholders and/or organization's website address:*

Has it received a donation from PGG in the past?*

Your relationship to the organization:*

Organization's Executive Director:

Organization’s Board President:

The Donation

Event at which the donation will be used:

The event’s goal:

What will the donation be used for?*

The specific donation you are seeking:*

If requesting food, how many people do you wish to serve with the contribution?

Any recognition to donors (at the event, prior, subsequent, etc):

Donation Details We will provide speci c information as to where donated product will be available for pick-up.

Date Needed*

Time needed*

Who will pick it up?

Person's work/home phones*