Donation Request Form

Name of Organization:
Address:
City: State: Zip Code:
Tax Status: Non-Profit For-Profit

Tax Identification Number:
**If your organization is a non-profit you must fax your Tax ID Letter to 630-241-2300**

Primary Contact Information (person to contact with any questions and where to send responses)

Name:
Relation to Organization:
Address:
City: State: Zip Code:
Phone: Fax:
E-Mail:

Please select one of the two available programs that you are interested in.

Community Event Donations *Request must be submitted at least (6)-weeks in advance*

Name of Event:
Date of Event (mm/dd/yy): Time of Event (hh:mm AM/PM): # of people attending:
Brief description of event (200 character max):

Donation Request for (please select all that apply):
Bread or Bagels For A Year Certificates
Fresh food

If requesting fresh food items:
Which Panera Bread bakery-cafe would you like to pick up from?
Street:
City: State:
Preferred Pickup Time(hh:mm AM/PM):

What food items would you like donated?(200 character max):

How do you plan to advertise Panera Bread as a Partner/Sponsor of your event?
(Proof must be furnished no later than 1 week prior to event date.)(200 character max):

Day-End Dough-Nation Program (For non-profit organizations only)

How will the leftovers be used?(200 character max)

Number of evenings interested in pick-up:    Evenings willing to pick up (select all that apply):
Monday    Tuesday    Wednesday    Thursday    Friday    Saturday    Sunday

All locations willing to pick-up (in order of preference) Please include City and Street Name
1:
2:
3:

We agree that if approved, our organization will pick up the leftovers every week on our assigned evening/s and that all leftovers will be used for the exempt purpose of caring for the ill, the needy or infants and that we will not require any money, property or services in the exchange for the transfer or use of your donation. Upon request we agree to provide Panera with a written statement confirming our organization's donation of the food products complies with these requirements.

Name:    Title:    Date (mm/dd/yyyy):

I would like to receive a copy of this information in my E-Mail
E-Mail:

We try to respond to all community event donation requests and Day-End Dough-Nation requests within (4)-business weeks. Submitting a request form does not guarantee approval.