Max & Erma's Donation Request Form

Max & Erma's is proud to support the communities in which we do business. In order to be considered for a donation of funds, food, coupons or gift certificates, an organization must submit this completed request form.

We support organizations that benefit children and education in the communities that we do business. Max & Erma's donations are not intended to be used by individuals or groups collecting personal or corporate profit.

To be considered, all requests must allow a minimum of 2 weeks notice. Information provided on this form will be used to help us evaluate your organization's request and communicate our donation procedures.

Due to the quantity of donation requests Max & Erma's receives, we are unable to fulfill every donation request. You will be contacted by a Max & Erma's representative within 2 weeks if we are able to fulfill your request.

* Denotes a Field is Required

Organization: *
Contact: *
Contact's Phone Number: *
Contact's Email Address: *
Position:
Max & Erma's Location: *	State: Restaurant: -- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -- Select Restaurant --
Ship-to Information:
Address: (NO PO Boxes)
City:
State:	-- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Phone:
Organization Status: *	-- Select Organization Status -- Corporation Individual/Sole Proprietor Non-profit Other Partnership
If Other Status:
Type of donation: *	-- Select Donation Type -- Coupon Food Funds/Sponsorship Gift Certificate Other
Date of event, if applicable:
Please use the space below to describe the donation you are requesting in detail & the intended use of your requested donation.