Form - Dine & Donate

Dine & Donate Request

Please fill out this form completely and submit it at least four weeks prior to the date the dine & donate is needed. We will respond within two weeks.

The donation amount is 10% of sales on the approved Dine & Donate date (not including sales tax). Marketing is the responsibility of the Dine & Donate recipient.

Please, enter a valid organization seeking donation Organization seeking donation - Required Please, enter a valid purpose of organization Purpose of organization - Required Please, enter a valid 501(c)(3) tax id number 501(c)(3) Tax ID Number - Required Please, enter a valid contact name Contact Name - Required Please, enter a valid email Email - Required Please, enter a valid organization street address Organization Street Address - Required Please, enter a valid city City - Required Please, enter a valid state State - Required Please, enter a valid zip Zip - Required Please, enter a valid select a restaurant Select A Restaurant - Required

Additional Details - Optional

Please check errors in the form above

THANK YOU FOR YOUR DINE & DONATE REQUEST.

Dine & Donate Request

Email Signup