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Western Drug & General Store 106 E. Main Street
Springerville, AZ 85938
P: 928-333-4321

Store Hours: MON-FRI 9am - 7pm, SAT 9am - 6pm, SUN 9am - 5pm (PHARMACY OPEN: 10:30am - 2pm)
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Donation Request Form

Helping those in our community is very important to all of us at Western Drug.  If your organization is in need of our assistance, please complete the following information. Once our management team has had time to review your request, we will send you an email outlining our response. 

Note: * indicates required information

Personal Information

Name*
(First, Middle, Last)
Street Address*
City, State, Zip Code*
Phone*
(xxx-xxx-xxxx)
Email address*

Organizational Information

Name of Non-Profit Organization*
501(c)(3) Number
State and local MTNA affiliates may apply for 501(c)(3) status through MTNA's group exemption process. Among the advantages of 501(c)(3) status, affiliates can accept charitable contributions that will be tax deductible to the contributor and claim exemption from state sales tax.
Can you provide proof of 501(c)(3) status?*

Type of Donation Requested

How do you wish us to fulfill your donation request?*
Gun, Ammo or Fishing Item
Fabric or Craft Item
Health or Beauty Item
Gift Item
Cash or Check
Gift Card
If cash, check or gift card has been selected, please type the dollar amount requested*
Please tell us anything else you would like us to know about how this donation will be used to better the community.

Thank You!

Thanks very much for filling out and submitting a request. We appreciate the opportunity to partner with you to make our community a better place. (Be sure to click the Submit Form button below so that we receive your request.)

Note: * indicates required information.