Nonprofit Furniture Request Form | Office Furniture Dealer In Ohio

Organization Name*

Delivery Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is your Organization a register 501(c)3?*

If yes, please provide your EID/TIN

Has this organization received items from Connecting the Dots in the past? If yes, when?

Please list the office furniture items that you have an immediate need for:

Is your mailing address different than the delivery address?

Mailing Address (if different than above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Person*

Title or Relationship to Organization*

Phone*

Email*

Website

Please tell us a little about your organizations mission and the impact you have on the community: