Heartland Cooperative Services
101 Parkside Dr.  Dorchester, WI 54425
715-654-5134 or 1-800-521-2021
HomeFutures-Cash-BidsCoop NewsAg NewsAgronomyGrainFeed
Live StockFuelLubricantsPropaneNAPAC-StoresCountry Stores
Location-Contact InfoCustomer Account AccessEmploymentHealth & Safety

AGRICULTURE - INDUSTRY - RURAL LIVING
Request for Donations
Organization Name
Insert text here.
Contact Phone Number, (Include area code)
Contact name
Contact email address
City
Address
State
Zip
Monetary donation amount requested
Product(s)  & quantityrequested
Reason for request: I.E. What will the product or money be used for?
If this is for a event, state date and location 
Provide brief description of event
Who should the check be written to?
If product needs to be delivered please provide location and time.
City
Address
State
Zip
Delivery time
Event Date
Organization or contact address
Event Location
Requested donation is needed by what date?
All requests will be reviewed on a first come first served basis. Please submit request one month prior to event. 

Please visit our websites for information on our companies at:
www.heartlandcooperativeservices.com and www.omegavalleyfarmers.com
100 Parkside Drive, Dorchester, WI, 800-521-2021 

Today's date
Organization address
Contact address