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Time and Goods Donation Form
Time and Goods Donation Form
Professional Time Donated
Full Name of Professional Volunteer:
First
Last
Date of Volunteer Contribution:
MM slash DD slash YYYY
Hourly Professional Pay (Enter Hourly Rate):
Total Number of Hours:
Name of Charitable Agency Served:
Agency Main Address:
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Address where services were provided:
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Name of Main Contact:
First
Last
Cell of Main Contact:
Email of Agency Contact:
Total Estimate of Time Contribution:
Tangible Goods Donated
Please complete a separate form if the recipient is a different charitable agency.
Date of Contribution:
MM slash DD slash YYYY
Description of Goods:
Real or Estimated Value of Goods:
Is this the:
Actual Value
Appraised Value
Other
Who made the determination of value and how:
Please attach a picture (or pictures) of the donation:
Drop files here or
Select files
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 50 MB.
Total Estimate of Goods Contribution:
Order Total:
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