Donation Request Form

Request For Donation

Thank you for your donation request

Thank you for your donation request. Please allow 3-5 business days for a response from our Marketing Coordinator: Mollie Coddington – mollie.coddington@nlcoop.com

Organization Name

Contact Person

Phone Number

Email address

Date of Event or Deadline: (YYYY-MM-DD)

Event or Purpose of Donation:

Donation Requested(required)

Gift Card Product Other

Are you a Patron Rewards Member for Northern Lakes Cooperative?(required)

Yes No Not yet – would like to become a member

Any additional information you would like us to know?

Once completed, we will contact you for any further information needed, and to process your request. Please allow 3-5 business days for a response.