Donation Request

Please complete this form to apply for a donation or advertising support from Smith Home Furnishings. Allow TWO WEEKS prior to the donation deadline for processing and consideration. NOTE: Priority is given to organizations over individuals. Approval is not guaranteed and subject to availability of funds. If approved, applicants will be contacted via text message when the donation is ready for pick up. Requests missing proper documentation will NOT be considered. Thank you!

Donations are only considered and approved for LOCAL organizations within 20 miles of our store, located in Ponca City, Oklahoma. Applicants must be able to visit Smith Home Furnishings as requested, to show proof of establishment and to pick up donations. Does this request meet this criteria? If NO, please stop here and seek assistance elsewhere:

Donations are only considered and approved for LOCAL organizations within 20 miles of our store, located in Ponca City, Oklahoma. Applicants must be able to visit Smith Home Furnishings as requested, to show proof of establishment and to pick up donations. Does this request meet this criteria? If NO, please stop here and seek assistance elsewhere: YES
Organization / Payable To Name:

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 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
*Address must be within 20 miles of our store. Applicants must be able to visit our store in-person to show proof of establishment and pick-up approved donations. If your request does not meet these requirements, you've already gone too far! Stop here and seek assistance elsewhere.
Donation Deadline: Donation Deadline: / MM / DD YYYY

Request MUST be submitted two weeks or more in advance of the the donation deadline.
Please list the monetary amount, merchandise type or advertising support requested:

If monetary, please list amount. If merchandise, please list type and purpose (auction, door prize, etc.). If advertising support, please list type of ad. MUST attach documentation below to be considered.
Please upload a file or image that documents the authenticity of this request:

Event Flyer, Letterhead Document, Screenshot or Image of Event Announcement, etc. Supporting documents are strongly encouraged. Request missing documentation will NOT be approved.
Signature of Requester (Draw or Type):

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.