Donation Request Form

Requests for charitable donations will only be considered if requested on this web site using the on-line form, submitted per instructions and meet the Preservation Trust guidelines. Organizations must meet 501c3 status and be within a 50 mile radius of our historic sites. No contributions will be made to fundraisers supporting political organizations or religious institutions. Thank you.

Contact Information

First name*

Last name*

Title

Organization*

Are you a 501(c)3 organization?*

 Yes

 No

Email address*

Phone*

Event Information

Description of event*

Event Date*12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 20122013201420152016201720182019202020212022

Attach file/request letter

Paste or type request letter

Where to Send Donation

Address 1*

Address 2

City*

StateSelect oneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonDistrict of ColumbiaWest VirginiaWisconsinWyoming

Zip code*

Country*Select oneAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBarbadosBangladeshBelarusBelgiumBelizeBeninBermudaBhutanBotswanaBoliviaBosnia and HerzegovinaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, Democratic RepublicCook IslandsCosta RicaIvoire (Ivory Coast)Croatia (Hrvatska)CubaCyprusCzech RepublicDenmarkDjibouti--Add Me - module:FormBuilder string:DM --Dominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanGuernseyFrench PolynesiaFrench Southern TerritoriesF.Y.R.O.M. (Macedonia)GabonGambiaGeorgiaGermanyGhanaGibraltarGreat Britain (UK)GreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelIsle of ManItalyJerseyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea (North)Korea (South)KuwaitKyrgyzstanLaosLatviaLebanonLiechtensteinLiberiaLibyaLesothoLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMonacoMoldovaMoroccoMongoliaMontserratMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNeutral ZoneNew CaledoniaNew Zealand (Aotearoa)NicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaS. Georgia and S. Sandwich Isls.Saint Kitts and NevisSaint LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSloveniaSlovak RepublicSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Pierre and Miquelon SudanSurinameSvalbard & Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUS Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaViet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabwe

Please enter the letters from the image.