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For consideration, all submissions must be made at least 4-weeks prior to event. Late requests cannot be guaranteed for review.

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Today's Date *

Contact Name *

Address (City/State/Zip) *

Contact E-Mail *

Donation Amount Requested ($) *

Donation/Gift Card to be used for? *

Purchase of products at Kessler's

Prize(s)

Both

Date Donation Needed *

Organization Name *

Contact Phone Number *

Event Explanation/Purpose of Event *

# of gift cards *

Value of each gift card if multiple requested ($) *

Does Club or Organization have non profit status? *

Yes

No

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