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Suzy Cares Donation
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Your Name
*
Your answer
Your Company
*
Your answer
Where are you located? (city, state)
Your answer
How many machines do you plan to donate?
*
Your answer
What type of device are you donating?
Your answer
When do you estimate having them ready to donate?
*
Your answer
Is there anything else we should know about your donation?
*
Your answer
Would you prefer a monetary donation?
Yes
No
Maybe
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How much would you like to donate?
Your answer
Would you like assistance in getting the devices shipped?
Yes
No
Maybe
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Please include our primary point of contact for accepting these devices.
Your answer
Will you need a receipt of donation? (for tax purposes)
*
Yes
No
Maybe
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