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
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 50 MB.
Total Estimate of Goods Contribution:
Order Total:

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