In-Kind Donation Form printable pdf download

In-Kind Donation Form

Name: _______________________________________________________________________

Company Name: _____________________________________________________________

Address: _____________________________________________________________________

City: _________________________________ State: ______ Zip Code: _________________

Telephone: (

) _________________ Email Address: _____________________________

Description of gift/donation (please be specific):

________________________________________________________________________________

________________________________________________________________________

Fair Market Value $ ________________________

Signature: _______________________________________ Date: ______________________

Thank you for your donation!

The Foundation for Ichthyosis & Related Skin Types, Inc.

is a registered 501(c)3.

All donations are considered tax-deductible to the full extent of the law.

Our Federal Tax Identification number is 94-2738019

In-Kind Donation Form