Small Town Scoop Charitable Donation Request Form

Small Town Scoop

Charitable Donation Request Form

Due to the high number of requests we receive, we are unable to fulfill every request. Priority is given to local organizations, schools, and community-focused causes.

Your support of our business helps us give back to local sport and youth opportunities. Thank you for being our loyal customer, so we can help you in return!

We will review donations, and will reach out at the end of the month to selected applicants only.

Organization Name

First Name

Last Name

Address

Email Address

Website

Phone Number

Is donation for a community event, team, charity, or personal request?

What will this donation support, and how does it benefit Murphysboro?

What is your requested donation?

What is your favorite ice cream flavor you get from us?

Are you a rewards member with us? If so, what is your rewards phone number?

When is this donation needed by?*

yyyy

How will Small Town Scoop be recognized for this donation?

How will donation be picked up or delivered?

Are you a registered non-profit?

Attachment

Drag and drop your PDF here

Small Town Scoop

Charitable Donation Request Form

Small Town Scoop Location and Hours