Donation Request

Date*
Month
Day
Year
Organization Requesting Donation*
Contact Person*
First Last
Email*
Phone Number*
Preferred Contact Method
- Email
- Phone
- Customer Will Call
Deadline for Donation*
Month
Day
Year
Type of Donation Requested
Which D&H Drugstore location do you do business with?
Additional Information / Comments
Please attach a PDF of JPEG of event flyer or advertising requested
Accepted file types: jpg, jpge, pdf, Max. file size: 9 MB.