Dierbergs Charitable Solicitation Request Form
This file contains the guidelines for requesting charitable solicitation at Dierbergs Markets. It includes information about necessary documentation and procedures to follow. Organizations seeking to solicit in stores will find detailed instructions to ensure compliance.
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How do I fill this out?
To fill out this form, start by providing your contact details and the organization’s information. Next, specify the date and time you wish to request for your solicitation event. Lastly, ensure to attach the necessary documentation as mentioned in the form.

How to fill out the Dierbergs Charitable Solicitation Request Form?
1
Provide your contact details and the organization’s name.
2
Specify the date and time for your solicitation event.
3
Attach the required documents like proof of 501(c)(3) status.
4
Ensure the form is signed by the Store Director.
5
Submit the completed form at least 30 days in advance.
Who needs the Dierbergs Charitable Solicitation Request Form?
1
Non-profit organizations seeking to fundraise.
2
Community service groups wanting to raise awareness.
3
Schools planning charitable events.
4
Religious organizations hosting community service days.
5
Clubs or associations gathering support for local events.
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What are the instructions for submitting this form?
To submit this form, please complete all required fields accurately. You can return it either via email to the Store Director or deliver it in person at the store location. Ensure you attach all necessary documentation, including proof of 501(c)(3) status and insurance certificate.
What are the important dates for this form in 2024 and 2025?
For 2024, request forms should be submitted at least 30 days before your event date. Important dates for charitable events should be coordinated closely with local Dierbergs management to ensure compliance with store policies. For 2025, check back closer to your event for any updates in the policy.

What is the purpose of this form?
The purpose of this form is to facilitate organized charitable solicitations at Dierbergs Markets. It allows organizations to apply for permissions to set up fundraising activities. This ensures that all activities comply with store policies and support community engagement.

Tell me about this form and its components and fields line-by-line.

- 1. Store: The location where you wish to solicit.
- 2. Today's Date: The date you are filling out the form.
- 3. Name of Organization: The official name of the organization requesting solicitation.
- 4. Contact Information: Details for the requestor, including name and phone number.
- 5. Date/Time Requested: Specify the date and time for your solicitation event.
- 6. Insurance Certificate: A certificate proving liability insurance for the event.
- 7. 501(c)(3) Status: Proof of non-profit status documentation.
What happens if I fail to submit this form?
If you fail to submit this form, your organization will not receive permission to solicit at the requested store. This could hinder fundraising efforts and limit opportunities for community engagement.
- Denied Requests: Your request may be denied, and you’ll need to address any outlined concerns.
- Lack of Compliance: Failure to comply with submission guidelines may result in the inability to conduct the planned fundraising event.
How do I know when to use this form?

- 1. Fundraising Events: When planning a charity fundraiser that requires in-store solicitation.
- 2. Community Awareness Campaigns: For promoting community service events where donations are sought.
Frequently Asked Questions
How do I request permission for solicitation?
Fill out the Dierbergs Charitable Solicitation Request Form with the required details and documentation.
What documents do I need to submit?
Include proof of 501(c)(3) status and a Certificate of Insurance as specified in the form.
When should I submit this form?
Submit the form at least 30 days before the date of your event to ensure approval.
Can multiple organizations solicit on the same day?
No, only one organization is permitted to solicit per day.
Is there a time limit on solicitation?
Organizations can only solicit for a maximum of eight hours on approved days.
What if my request is denied?
You may reapply after addressing any concerns raised by the Store Director.
Is a mask required for solicitors?
Yes, all solicitors who are not fully vaccinated must wear a mask.
Can I solicit inside the store?
No, soliciting inside the building is prohibited.
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