Home   Events   Donations    Fundraising              Contact
 

Chuckie's house of wine strives to take an active role in community organizations and charitable events, however, we cannot contribute to and support all events. In order to fairly and equitably assess all donation requests, we ask that you fill out the following form to briefly describe your request for evaluation.

You will be notified via e-mail should your organization's donation request be granted. Thank you for your interest in Chuckie's House of Wine.


Organization Name             Contact Name                    Phone Number
         

E-mail Address
    

Is your Organization registered under 501(c)3 ?

Yes     No

Non-Profit Tax ID (in applicable)

Briefly describe the mission or goal of your organization:
 

Name and type of event for which the donation is sought

 

Goal of the event

 

Date of event                      Date donation is needed
    

Type of donation:

Wine
Gift Card
Gift Basket

How will the donation be used?

Additional information (if necessary).

 

 


 

  

© 2006 Chuckie's House of Wine