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Charitable Request Form

Due to the high volume of requests received, we are unable to confirm the status of requests or receipt of requests by telephone. Although we are honored to receive many charitable requests, we are not able to support them all, and prioritize requests within our local community of Henry & Butts County.

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Requests are reviewed on a monthly basis and must be submitted at least 6 – 8 weeks prior to the event to be considered. A confirmation email will be sent to you within 24 hours, so please include a valid email address and contact information. Only approved requests will receive further communication after this initial confirmation email. Please be sure to check your spam/junk folder if you do not see the confirmation email in your primary inbox.

Organization Type
Are you a Moyes Pharmacy Customer?

Thank you for submitting!
A confirmation email will be sent to you within 24 hours, so please include a valid email address and contact information. Only approved requests will receive further communication after this initial confirmation email.

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