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Charitable Donations Request Form

Locos is proud to be a part of our community; therefore we actively participate in as many community outreach programs as possible. To ensure that all members of the community who are seeking support receive consideration, we are asking you to fill out the form below. We will review forms on a monthly basis - please make sure to give us 4 - 6 weeks notice on all requests; otherwise, we will not be able to consider them. Thank you!

NOTE: Fields marked with an asterisk (*) are required.

Charity Group Name:

Your Name:

Your Address:

Your Phone:

*Your Email Address:

Is your tax group exempt?
Yes No

Is your request in-kind (food, merchandise, etc.)? If yes, please provide us with your specific needs:

Is your request for cash? If yes, please provide us with your specific needs:

Locos location where you would like to send this request for charitable donation: