Charitable Donation Request Form

Atkins Farms is proud to contribute to our community. Each year we receive many requests from numerous worthwhile organizations. Our goal is to fulfill as many requests as possible. However, due to the overwhelming number of requests we receive, we are unable to support every organization's request.

If you represent a nonprofit organization interested in applying for a product donation from Atkins Farms Country Market, please review the following guidelines and provide the required information to be considered:

• Your organization must be a nonprofit organization.
• A cover letter using your organization's letterhead must accompany the completed request form.
• Your request must be filled out in full for consideration. Missing information will result in your request to be discarded.
• Forms can be filled out and submitted below or downloaded in PDF form to be filled out and emailed to info@atkinsfarms.com, hand delivered in person to our South Amherst location or mailed to the following address: 
  
  Atkins Farms Country Market
  1150 West Street
  Amherst, MA 01002
  Attn: Charitable Contribution Request

Only one (1) request will be granted per organization, per calendar year. If your donation request is approved, please be aware that we may not be able to provide you exactly what you asked for.

NOTE: If your organization has previously received a donation from Atkins Farms Country Market, this does not exempt you from this process nor does it guarantee approval. Please provide date of previous donation and description of what was donated, dollar amount donated, etc.

“At Atkins Farms Country Market, we support organizations that are important to our customers, with a focus on family, community, health, environmental issues, children, schools and the military.”

Name, address, phone number, and email of person requesting donation:

First Name:*

Last Name:*

Address:*

Telephone:*

Email:*

Name, address, and phone number of nonprofit organization: *

Describe your fundraising event and date (Include details, including what organization(s) benefit from fundraiser): *

Requested donation (If request is for refreshments, please provide number of people expected, etc.): *

Additional information:

Attach cover letter including organization’s letterhead or flyer pertaining to event: *

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Security Key:

Please enter the number displayed in the box.