DONATION RECEIPT REQUEST FORM

Date of Donation *

MM

DD

YYYY

Donor Type *

Individual

Organization

Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is donation new?

(tags still on/unopened items)

Yes

No

Mix of New and Used