Please complete entire form

Note: completion of the form does not guarantee approval of any donation request.

BuffaLouie’s management will contact organization regarding your request.

* denotes required fields.

Name of organization *
Person making request *
Email *
Address of organization
Organization's EIN number *
Is the organization a 501(c)3?
Requesting *
If Other, please specify:
Date of event for request *
(note: Requests must be made 30 or more days prior to the event/need)
Summary explaining the event
Summary explaining how donation would be utilized
How would BuffaLouie's be recognized for donation?
BuffaLouie's logo needed? *