Your First Name:     Your Last Name: 

Value of Donated Item in USD:       The in-kind donation is an:  Item      Service

Name of Company (if applicable): 

Please provide a brief description of the item(s) or service(s) donated (please note:  All donations of land, buildings or vehicles must have clear title and the title must be provided.  In addition, watercraft and motor vehicles must be in good working order.  Thank you. 

Your mailing Address: 

City:    State/Province:     Postal Code: 

Please provide a valid contact email address for yourself: 

Please provide a contact phone number with area code/country code (if applicable): 

How do you want your receipt?  By email        By mail