Contribution Request

Contribution Request Form

In order for us to consider your request, you must fill out this form and/or attach a request letter. The more we know, the better the chances of approval.

Name of Soliciting Organization*
Contact Phone Number*
Contact Email*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Tax Deductible Status: Federally Exempt?*
- Yes
- No
When do you need the contribution? (If date is less than 30 days from the submission date, your request may not be considered at this time):*
Solicitor's First Name*
Solicitor's Last Name*
Relationship to Organization*
What kind of service is rendered by your organization?*
What contribution are you seeking from us?*
What kind of recognition will result if we contribute to this cause?*
Have you or your organization purchased a vehicle from us?*
- Yes
- No
If yes, under what name?*
Are you or your organization a regular Parts and/or Service customer?*
- Yes
- No
Today's Date*
MM
DD
YYYY
Solicitor's Signature (please type or sign and print)*
By clicking this box, I agree to receive in-person or automated telemarketing calls and texts from Harry Green Automotive at the number I entered. I understand that my consent is not required for purchase.*
FName
This field is for validation purposes and should be left unchanged.

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Contribution Request

Contribution Request Form

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Contribution Request Form

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