In Kind Donation Form For Mentoring Usa Musa printable pdf download

In Kind Donation Form For Mentoring Usa Musa

Rev. 1/1/05

IN-KIND DONATION FORM FOR MENTORING USA

KINDLY PRINT ALL OF THE FOLLOWING INFORMATION

MUSA Site to receive donation (if applicable): _____________________________

Today’s Date: _________

Date of Donation: _________

Time: _____________

Name of Person Completing This Form: ___________________________________

Name of Donor/Organization: ____________________________________________

Name of Contact Person: _______________________________________________

Mailing Address:

_____________________________________________________

________________________________________________________________

Home tel: __(_____)__________________ Work tel: __(_____)_________________

Fax: __(_____)________________ Email: ___________________________________

Details of Donation (please itemize):

Condition (Excellent, Good, Fair, Poor)

Item

Value

TOTAL

____ I would prefer that my donation not be sold to a third party to raise funds to benefit

Mentoring USA’s programs and services.

To the best of my knowledge the amount of estimated value of the donation

represents the true fair market value of the donated items.

_____________________________________

________________________

Signature

Date

Please return to Mentoring USA, 5 Hanover Square, 17 Floor New York, NY 10004

Attn:In Kind Donations

Or fax 212-400-7034

In Kind Donation Form For Mentoring Usa Musa