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.

This should be
Donor First Name *
Donor Last Name *
Date of Donation
Please indicate when you made the donation.
MM
/
DD
/
YYYY
Company/Organization
(if applicable)
Street Address
Town/City
State
Zip Code
Phone Number
Email *
Items Donated *
Required
(Estimated) Value of Goods *
(Estimated) Number of Items
How will we receive the donations?
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.
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