Charitable Donation Request Form

All Charitable Donation Requests Must Be Made Through Our Website Using This Form

Click Here To Get More Information About Obtaining A Charitable Donation From Black Mountain Gallery

Before filling out this form, make sure you have read the Charitable Donation Information page by clicking the link above.
Organization's name: *
Organization's Non-Profit State ID Number: *
What is your organization's purpose? *
Please provide the organization's web address. (If applicable):
What event will the donation be used for? *
How will the donation be used? *
What is your event's date? *
What is the date you need the donation picked-up/shipped? *
Will the donation be picked-up at our location in Chapel Hill, NC? *
If No, please provide the shipping name and address:
Contact Person's Name: *
Contact E-Mail Address: *
Contact Telephone Number(s): *
When is the best time to reach the contact? *
Have you applied for a donation from us before? *
Have you received a donation from us before? *
Additional Comments:

Black Mountain Gallery @ 2007