LLS Donation Receipt Request

Are you the donor? *

Yes

No

Which of these best describes your role? *

LLS Staff

LLS Participant/Fundraiser

Other (fill in below): Other (fill in below):

What is your name? *

What is your e-mail address? *

Which of these best describes the type of donation? *

Corporate Donation

Individual Donor

Multiple Donors

Other: Other:

Donor First Name: *

Donor Last Name: *

Donor First Name: *

Donor Last Name: *

Donor Institution, if applicable:

Donor Street Address *

Donor Address Line 2

Donor City *

Donor State *

Donor Zip Code *

Donor Phone Number *

Donor Email Address *

Is this a single donation receipt request or an annual summary? *

Single Receipt Request

Annual Summary

Do you know the exact date of your donation? *

Yes

No

How many donations did you give to LLS during the year? *

Please fill in the date below: +

Please provide an approximate date range:

Please select the format which the donation was made: *

What is the donation amount? If this is a recurring donation, what is the monthly amount? *

Check Number:

Where did you make your donation?

Please specify the participant name and/or the event the donation was made to:

Additional Information: