Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Name *

First Name

Last Name

Phone *

(###)

###

####

Is this a non-profit organization? *

If no, then it is unlikely that your request will be accepted per our donation preferences.

Yes

No

When do you need the donation? *

Donation requests must be submitted a minimum of two weeks in advance.

MM

DD

YYYY

What kind of donation are you seeking? *

$30 Gift Card

Other

Acknowledgment of donation preferences *

I understand that donation preferences are given to registered non-profit organizations in the communities most commonly served by Medford Food Co-op; priority is given to organizations promoting local, organic food, food related issues, or community health concerns; and that individuals, commercial enterprises, and partisan organizations are not eligible for donations.