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In-Kind Donation Log & Receipt Request Form
Thank you so much for your donation. This form will be used for internal Haley House record-keeping only. We will not share your information.
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Donor First Name
*
Your answer
Donor Last Name
*
Your answer
Date of Donation
Please indicate when you made the donation.
MM
/
DD
/
YYYY
Company/Organization
(if applicable)
Your answer
Street Address
Your answer
Town/City
Your answer
State
Your answer
Zip Code
Your answer
Phone Number
Your answer
Email
*
Your answer
Items Donated
*
Men's Clothing
Men's Shoes
Men's NEW socks
Men's NEW underwear
Men's Winter/Rain Gear
Travel-sized Toiletries
Backpacks/totebags
Accessories (belts, umbrellas, zipper pouches)
Kitchenware
Sleeping bags & blankets
Food (approved or from list on website)
Misc. Items from Amazon Charity List
Women's clothing
Other:
Required
(Estimated) Value of Goods
*
Your answer
(Estimated) Number of Items
Your answer
How will we receive the donations?
I dropped them off at Haley House
I sent them in the mail
I ordered through Amazon Charity Lists and they shipped directly
I ordered online and they shipped directly
Other:
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Comments/Notes
Please note: if you are filling this out on behalf of another person/organization, please share your name and contact info here. If you haven't yet dropped off your donation, please indicate when you plan to drop it off here.
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