Online In-Kind Donation Form

Please only complete this AFTER a donation has been completed.

Date of donation*
Organization or Individual Name*
Contact Name (for organizations only)
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred phone number
Would you like a receipt?*
- Yes, please e-mail it to me
- Yes, please mail it to me
- No receipt, please
Items donated*
Please provide a clear description of each item donations with quantities
New or Used*
- New
- Used
Estimated value*
For Office Use Only: SHS Staff Name