DAF Distribution Request

First Name:
Last Name:
Email Address:
Street Address:
City:
State:
Zip:
Amount of Contribution:
Special Designation:
Name of Charitable Organization:
Address of Charitable Organization:
Special Instructions:
   

By entering your initials below, you are agreeing to these terms:

  • I (We) understand this is only a recommendation to the Ambassador Foundation.
  • I (We) will not receive goods or services from this distribution, and the distribution is not directly given to an individual.
   
Intials:
   
You will receive a confirmation when our office receives this coupon.