Donation Request Form

Blain’s Farm & Fleet is proud to support charitable initiatives that align with our mission, vision, and values—especially those focused on youth development, agriculture, and animal welfare, as well as community programs that directly connect to the products and services we offer. While Blain’s highly values community outreach, you will not receive a response if we are unable to participate/fulfill your request.

Charity Name *

Contact Person *

First

Last

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Where check or merchandise will be mailed

Name of Event/Activity *

Start of Event/Activity *

Date

Time

End of Event/Activity

Date

Time

When do you need a decision? *

Area/Community the Event/Activity will serve *

Nearest Blain's Farm & Fleet Store *Baraboo, WIBelvidere, ILBloomington, ILBourbonnais, ILCedar Falls, IAChippewa Falls, WIClinton, IADavenport, IADecatur, ILDodgeville, WIDubuque, IAElgin, ILFreeport, ILGeneseo, ILGrafton, WIHolland, MIJackson, MIJanesville, WILa Crosse, WILoves Park, ILMadison, WIMoline, ILMonroe, WIMontgomery, ILMorton, ILMuscatine, IAOak Creek, WIOttawa, ILPlatteville, WIPortage, MIRhinelander, WIRockford, ILRockton, ILRomeoville, ILRice Lake, WIStandale, MISterling, ILSturtevant, WISycamore, ILTraverse City, MIUrbana, ILVerona, WIWatertown, WIWaukesha, WIWoodstock, IL

What is the purpose/importance of this event to the organization? *

How does the Event/Activity support youth development, agriculture, animal welfare, or community programs that directly connect to the products and services we offer? *

What are you requesting from Blain's Farm & Fleet? Be specific. *

Has Blain's Farm & Fleet previously donated to the Event/Activity? *

• Yes
• No

If so, when? *

Amount or Item(s) *

How will Blain's Farm & Fleet be recognized for its donation? *

Does your organization plan to make additional requests within the next six months? *

• Yes
• No

Are you a Blain's Farm & Fleet employee? *

• Yes
• No

Submit