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 promise not to share your information.
First Name *
Your answer
Last Name *
Your answer
Company/Organization
Your answer
Email *
Your answer
Street Address
Your answer
Town/City
Your answer
State
Your answer
Zip Code
Your answer
Phone Number
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Items Donated *
Required
Estimated Value of Goods *
Your answer
Estimated Number of Items
Your answer
Comments/Notes
Your answer
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