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2. Contact Information

   Please provide your contact information below.

4. Name
5. Email Address
7. Address
8. Phone Number
10. City
11. State
12. Zip Code
14. Donation Type

    1. Bench
    2. Tree
15. Preferred Location

    If you have a preferred location indicate it here. Locations are not guaranteed and are submit to availability and other conditions.

17. Acknowledgement

    All donated funds will be placed into an account managed by the Town of Bedford for the intended purpose. Funds shall be accessed by the Town at a future time when installation or replacement of a bench or tree is required. The Town makes no guarantee of the timeline for this installation.

    1. Yes, I understand and agree
    2. No
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field