Gift Card Donation Request

An asterisk (*) denotes required fields. Please note that a submission of a gift card donation request does not guarantee receipt of a donation.

Date of Donation Request

MM/DD/YYYY

Information About Your Organization

Name of Organization

Does Organization have 501(c)(3) status?

Yes

Tax Exempt ID#

Website

Contact Person

Email Address

Must be a valid e-mail address, e.g. email@domain.com.

Phone Number

(XXX) XXX-XXXX

Street Address

Address Line 2

City

State / Province / Region

Zip Code

Country

Description of Organization's Focus & Mission

How does the proposal fit with The Hub's Mission?

Promotes cycling or other forms of active transport

Promotes environmentally friendly initiatives

Program or event is within The Hub's business communities (Local)

Select all that apply.

What is the project or event for which the gift card will be used?

Total Requested Gift Card Amount

Date the Gift Card Donation is Needed

MM/DD/YYYY