Donation/Special Pricing Application

*First Name

*Last Name

*Phone

*Email

Wine Club Member No
Yes

*Donation or Special Pricing Donation Only Donation and/or Special Pricing Special Pricing

*Charity Name

*Charity Address

Charity Address2

*Charity City

*Charity State

*Charity Zip Code

E.I.N. for 501(c)(3)

*Event Name

*Event Date

Event Description

*Event Location

Event Website

Donation Request Wine (specify Quantity below)
Winery Tour Certificate
Wine Tasting Certificate
Other

Number of Bottles

Comments

Talley Vineyards will be promoted through (Check all that apply) Auction Catalog
Email Campaign
Event/Charity Website
Event Program Booklet
Media / PR Release
Newsletter
On-site Banner
On-site Promotional Display
Other

Leave this field blank:

  Submit