ORGANIZATION
Organization Name: ___________________________________________________________
Check the Type of Organization:
___ Non-Profit
___ For-Profit
___ Individual
Town/County: ____________________________________________________________________
Tax ID #: ___________________________________________________________________
(Please provide completed ST-119.1 from the NY State Department of Taxation and Finance)
CONTACT
Name & Title of Contact Person: _________________________________________________
Phone Number: ______________________________________________________________
E-mail Address: ______________________________________________________________
Mailing Address: _____________________________________________________________
___________________________________________________________________________
Signature: ___________________________________
Date: ________________________
EVENT
Name of Event: ______________________________________________________________
Date of Event: _______________________________________________________________
Event Description: ____________________________________________________________
___________________________________________________________________________
DONATION REQUEST
___ 50% off wine purchase
___ Gift Card(s) - Number of Cards & Amount of Each:_____________________________
___ Other ________________________________________________________________
PICK-UP / DELIVERY
___ A person from the organization will pick up donation from Atwater Estate Vineyards
___ I will make arrangements with Atwater Estate Vineyards to ship donated goods