Donate Form

This is the equipment donations form. Please fill it out with as much information on each piece that you have; we must have make and models on everything submitted. It's a very large industry, and this will help us help you! We work nationwide; please provide us as much information as you can. If you have more than 5 pieces, please fill in the first part of the form, then write a summary of what you have in the comment section and be sure to include a current email and phone number and we will contact you directly. We do not leave a public phone number here, but you will be contacted if we can assist you. Please note: If you do not tell us where you live, or what you have to donate, we will not contact you. We do not accept any broken equipment. Thank you.

Step 1

(1 out of 4)

First Name: *
Last Name: *
Organization:
Address:
Address CONT:
City:
Zip Code:	(5 digits)
State:
Phone:
Fax:
Email: *
Please tell us what you have to donate and any other comments:	*Must fill this box in.

*To Continue, scroll up and select the next Step*

Step 2

Continued...(2 out of 4)

How long will equipment be available? List type of equipment and dates available.	1) 2) 3) 4) 5)
How old is it. List equipment and approximate ages.	1) 2) 3) 4) 5)
Was it purchased new or used? What year?:	1) 2) 3) 4) 5)
Is the equipment paid for? (Federal law prohibits taking tax deductions on items you did not personally pay for):	1) 2) 3) 4) 5)
Where was the equipment used?:	1) 2) 3) 4) 5)
For how long?:	1) 2) 3) 4) 5)
Is it still being used?:	1) 2) 3) 4) 5)

*To Continue, scroll up and select the next Step*

Step 3

Continued...(3 out of 4)

How many hours a day?:	1) 2) 3) 4) 5)
Is the equipment in storage or no longer being used?:	1) 2) 3) 4) 5)
When was the last time it was used/ how long in storage?:	1) 2) 3) 4) 5)
Is the equipment in working order? If an electronic item, please turn them on and tell us if they work:	1) 2) 3) 4) 5)
Brand names(s):	1) 2) 3) 4) 5)
Model Numbers:	1) 2) 3) 4) 5)
Serial Numbers if any:	1) 2) 3) 4) 5)

*To Continue, scroll up and select the next Step*

Step 4

Continued...(4 out of 4)

Year Purchased?:	1) 2) 3) 4) 5)
Equipment bought new or used?:	1) 2) 3) 4) 5)
Used in what kind of facility? / How many hours a day?:	1) 2) 3) 4) 5)
Was it Maintained?:	1) 2) 3) 4) 5)
Repair History:	1) 2) 3) 4) 5)

NOTE: Please be aware that we can not take all equipment. Sometimes the equipment can not be repaired, or is not in demand. We reserve the right to accept as much or as little of your kind donations as we have need for.

Other Donations

Complete the fields with as much information as you feel is needed to explain what service(s) you offer or anything else you would like to donate.

Full Name:
E-Mail:
Services/Other Items Description: