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Mercury Donation Request Form

Intro
Please note: This form must be filled out completely and accurately -- including all demographic information -- to be considered for a donation. Failure to do so will result in an automatic declination. 
Pick Organization Country and Type
Organization Search


Organization Info
Please fill out any missing organization information below.
If you know the Tax ID it will speed up the processing and verification of your request.
Requester Primary Contact Information
The person completing this form who wishes to receive email updates should be entered here
Event Details
(include Street, City, State and Postal Code)
Donation Request Form
If you are requesting that items be shipped, please enter your shipping information below:
/ *
Confirmation

for example Event flyer if nothing specified (Click on Upload File button to attach multiple documents. The files should be selected from a folder on your computer. The files will be listed under the attachment box. Files will be uploaded when you click submit. Attachments must be in one (1) of the following formats: Pdf, doc, docx, xls, xlsx. Limit the file size to less than 10MB.)
* Denotes required fields
This form will expire after 2 hours.
A DonationXchange account will be created and provided in the confirmation email for tracking purposes.