IN-KIND DONATION FORM

Contact Person *

First Name

Last Name

Phone Number *

(###)

###

####

How will we receive the item(s)? *

Will be emailed

Will be mailed or delivered to our office

Will need to arrange for pick-up

If you need to arrange for pick-up, where is pick-up location?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

When will the item(s) be ready? *

MM

DD

YYYY