Donate Form

This is the equipment donations form. Please fill it out with as much information on each piece that you have. If you just put 'Treadmill' in the form, you will not be contacted. 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 have taken our phone number down due to individuals seeking equipment leaving abusive messages. 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: *
Comments:	Enter additional information: Upstairs? Need to be disassembled, etc.

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

Step 2

Continued...(2 out of 4)

What kind of equipment is it? (treadmill, upright bike, recumbent bike, free weights, weight machine, elliptical etc.) And how long will equipment be available?:	1) 2) 3) 4) 5)
Brand Names and Model Numbers:	1) 2) 3) 4) 5)
Was it purchased new or used? What year?:	1) 2) 3) 4) 5)
Are you the person who purchased this equipment? (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 no longer being used?:	1) 2) 3) 4) 5)
When was the last time it was used?:	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)
Can you send pictures if we need to use to contact recipients?:	1) 2) 3) 4) 5)
Reasons for wishing to donate said equipment:	1) 2) 3) 4) 5)
Was equipment in direct sunlight?:	1) 2) 3) 4) 5)

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

Step 4

Continued...(4 out of 4)

How many people used equipment:	1) 2) 3) 4) 5)
Has equipment been stored inside or outside:	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: