Organization Name:

Event Name:

Parent Organization (if applicable):

Please tell us about your event in detail (purpose, activities offered, etc.):

Event Address:

Event City:

Event State: ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Event Zip:

Event Date (yyyy-mm-dd):

Total People Expected at Event:

Organization: ReligiousEducationalCharityOther

Where will attendees be coming from? AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

If your donation is approved, you will receive further instructions via email regarding the pick up location.

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Drinks must be kept cold in a refrigerator or in a cooler on ice.

How will Milo’s Drinks be served at your event and to whom?

Will any other beverages be served at your event?NoYes

If yes, please tell us the other beverages

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Your Name:

Your Day Phone:

Your E-mail:

Your Address:

Your City:

Your State: ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Your Zip:

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Release of Liability/Hold Harmless Agreement (“Agreement”)

I agree that I am requesting donation of Milo’s product(s) (“Product”), which is good and valuable consideration in exchange for entering this Agreement. Should Milo’s, in its sole discretion, decide to accept my request for a donation of Product, I agree to be bound by the following:

Milo’s Tea Company, Inc. (“Milo’s”) received no money for this donation and I accepted this item in “as is” condition. I agree to release Milo’s and its past and present shareholders, directors, officers, members, employees, agents, parent, subsidiaries, successors, affiliates, attorneys, assigns from all damages, losses, rights or claims related to the Product.

In accepting the item “as is” I understand that it comes without a warranty. I will not hold Milo’s responsible for any defects. I also understand that Milo’s will not be held liable, under any circumstances, for any damages resulting from the use or inability to use the Product.

I agree to hold Milo’s harmless against any damages, costs, and expenses that may arise or result from the handling, consumption, disposal, transfer, or use of the Product. This includes, but is not limited to, lawsuits, judgements, settlements, costs, expenses, attorney fees, or any other costs. Nor do I expect Milo’s to assist or present any defense regarding claims or any other cause of actions I may take related to this Product.

I agree to be bound by the Agreement above.*

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