New Donee Registration

PLEASE REVIEW AND ACCEPT THE DONEE REGISTRATION AGREEMENT

NEW DONEE REGISTRATION AGREEMENT

I have read and accept the agreement.

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PLEASE FILL OUT YOUR ORGANIZATION PROFILE

Organization Name

Website

Department/Division

P.O.Box

Street Address

City

State

Zip

County

Phone

Fax

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PLEASE FILL OUT YOUR AUTHORIZED INDIVIDUAL PROFILE

First Name

Last Name

Title

Department/Division

Phone

Fax

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PLEASE FILL OUT YOUR DONEE PROFILE

Organization Type

Description of Program/Services/Facilities

# of People Served in the Community

# of Employees Full-Time

# of Employees Part-Time

Sources of Funding

Tax Supported

Grant

Contibutions

Other

Sales Tax Exemption

Other Licence

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PLEASE UPLOAD ATTACHMENTS FOR YOUR DONEE PROFILE

UPLOAD ATTACHMENT

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UPLOADED ATTACHMENTS

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PLEASE REVIEW AND SUBMIT YOUR REGISTRATION

NEW DONEE REGISTRATION

ORGANIZATION PROFILE

DONEE PROFILE

AUTHORIZED REPRESENTATIVES

UPLOADED ATTACHMENTS

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