Donation Request "*" indicates required fields Thank you for contacting Shakers about your upcoming fundraiser! Please fill out the form below and we will be happy to send you2 Free Self Service Dog Wash Certificates (value:$21 each, $42 total) Organization Name* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name* First Last Phone*Email* Event Date* MM slash DD slash YYYY Event Time* Hours : Minutes AM PM AM/PM Type of Event* Your 501c3 Tax ID #* DocumentsMax. file size: 256 MB. Good luck with your event! PhoneThis field is for validation purposes and should be left unchanged.