JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
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.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
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
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:
Clear selection
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.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Haley House.
Report Abuse
Forms
