Donation Request Form

Thank you for contacting Walton Insurance Group to help your organization or cause!

Please give us more information about your request. Each request is reviewed and will be provided a prompt reply.

Name of Organization
501c3 Number
Organization's Website
Organization's Facebook Page
Contact Person
Email
Phone Number
Describe your organization and how the donation will be used.
Amount of Request
Deadline for Donation
Do you pledge that your organization's use of any donation from Walton Insurance Group will not discriminate against those it serves based on race, color, religion, gender, national origin, disability, marital status, veteran status, sexual orientation, or other basis prohibited by law?
Upload a file for our review. For example: a donation form or a sponsorship form. (.PDF file format)

Note: If you need to speak with someone immediately, please call 517-787-2600. Some helpful information: opt-out policy, privacy policy, and terms of use.