Donation Request Form

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Note: You will be required to pickup your donation from a Purdys store.

*Indicates required field.

· Event and Organization Information ·

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- Required Field
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  Event Date:
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  Event Location:
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  City:
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  Postal Code:
Charity Number:
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  What type of donation are you looking for?
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  Organization Name:
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  Organization Type:
If "Other", please specify:
Organization/Event Website:
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  Expected # of Attendees:
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  Where would you like to pick up the donation?
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  Please describe what the event is about, and who (if any) the beneficiaries are:
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  Please describe the kind of recognition (if any) that will be provided for Purdy's by contributing to this event:
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  Contact Name:
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  Contact Email:
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  Contact Phone:
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  Account Number:
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  Contact Address:
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  City:
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  Province:
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  Postal Code:
Yes, I'd like to learn more about fundraising opportunities using Purdy's Chocolates
 Yes
*
  If my request is approved, I agree to pickup my donation from the selected Purdys store
 Yes

PLEASE NOTE: Purdy's Chocolates will never share, sell, or rent individual personal information with anyone for their promotional or any other use. For more details, please see our Privacy policy.