Lifeworks Donation Intake Form printable pdf download

Lifeworks Donation Intake Form

LifeWorks Donation Intake Form

Thank you for your donation to LifeWorks! Please fill out this form so that we can

make sure your gift is acknowledged and put to use appropriately.

Date: ___________________

Name: ________________________________

Business/Organization: ______________________________________________

Mailing Address: ___________________________________________________

City, State, Zip Code: ______________________________________________

Phone Number: __________________

Email Address: ____________________________________

Description of In-Kind Goods/Services:

List (or attach a List of) the items donated (if applicable).

Estimated value of in-kind goods/services: _____________

LifeWorks cannot determine the value of in-kind donations. It is up to the donor to determine fair market value of the goods

and/or services being donated. Donors may wish to get a professional valuation on gifts over $250.00

Do you want your donation to go to a specific program? If so, please list it here.

Otherwise, your donation will go to wherever it is most needed.

Program:

LifeWorks Use: Please return this form to Mitch Weynand at the South site by email or courier.

Lifeworks Donation Intake Form