Donation Request

Please complete this form to apply for donations from Smith Home Furnishings, allowing two weeks prior to the date of function for processing and consideration. Please note: Priority is given to organizations over individuals.

Name of Organization / Payable To:

*Donations are only considered/approved for organizations in Northern Oklahoma and Southern Kansas located in our service area. Must be able to visit our store as required to show proof of establishment.
Contact Person:
Text Friendly Cell Phone: Text Friendly Cell Phone: - ### - ### ####

*This number will be used to send text message updates to for this request.
Email Address:

This email will be used to send confirmation that this request has been submitted.
Address: Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
*Must be an address in Northern Oklahoma or Southern Kanas. Must be able to visit our store to show proof of establishment.
Date of function: Date of function: / MM / DD YYYY
Please explain the type of item, monetary amount, or advertising support you are requesting:

If monetary, please list amount requested. If an item, please explain its purpose such as auction, door prize, etc. If requesting funds for program advertising, please list details and attach documentation below.
Please upload any files, supporting your request:

Attach Files
Signature of requester (please draw your signature below):

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.