Please waitseconds before submitting another form. cancel Today's date First name Required Last name Required Phone Required Email Required Mailing address About your organization Organization name Is it a 501(c)3? If so, please submit a copy of the tax-exempt certificate. Yes No Has the organization received a donation from Shipwreck H-D® in the past? Yes No If so, when? Do you own a Harley®? Yes No If so, what type? Your relationship to our organization, if any The event at which the donation will be used The event's goals The exact donation you are requesting What will the donation be used for? Auction item Price item Raffle item Other How many people are expected to attend your event/how many people do you wish to serve? Date needed Will pick up? I accept that information and marketing preferences I submit through this webpage will be submitted to Shipwreck Harley-Davidson. Submit This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
