Direct Donation

Member Name

Member Email Address

Farm ID

Event Name *

Event Description *

Donation Type

Cash Value Requested

Requested Product Description

Organization Name

Organization Type

Recipient Shipping address

Please attach W9: Request for Taxpayer Identification Number and Certification. Link to W9

Donation Attachment W9

Please select a file

Donation Attachment Other

Please select a file

I certify that the information submitted is correct, that my request complies fully with the provisions of Land O’Lakes Foundation Direct Member Donation Program as described in this application, and that no benefit or service is accruing to me.

Signature

Date component