Product Donation Request Form

Organization Name*
Federal Tax I.D. Number*
Contact Name and Title*
Address Line 1*
Address Line 2
City*
State*
Zip*
Contact Phone*
Contact Email*
Date of Request
Event Name
Date of Event
Event Description
Event or office location*
Please indicate if you can pick up product in either Union City, or La Porte.*
What is the mission of your organization?*
Please describe the community that the donation benefits*
Please quantify how many community members the donation benefits, if possible
If donation request is for product, are you selling it or giving it away?
Product and quantity requested or amount requested*
Preferred Date and Time for Donation Pick Up

(Available pick-up days and times: LaPorte - Monday – Friday, between 8am to 4pm; Union City – 12:30 PM to 2:30 PM Monday - Friday)

What benefits/recognition would American Licorice Company receive if this donation/sponsorship were to be granted?*

No donations will be granted unless received at least thirty (30) business days prior to event.

  • All donation request forms must be completed in full or will not be considered.
  • Attach any additional information regarding the event/cause you wish to be considered.
  • American Licorice Company will do its best to support you in your efforts to achieve a successful event, although we may not be able to fulfill your request OR we may not be able to fulfill your request in its entirety.
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