Product Purchase Form

Organization Information

Organization Name

Email Address

Website

Phone

Year Established

Federal Tax Exempt No.

Address

Address 2

City

State/Zip

Primary Contact Information

First Name

Last Name

Email

Phone Number

Event Details

Event Name

Event Date

Event Location

Event Sponsor

Event Description

Has your organization worked with us before?

YesNo

Product Details: Please list your proposed donation products by putting a quantity in the spaces below. Product based on age range.

	Male	Female
2-3
4-5
5-7
8-10
Teen
Adult

Comments

Date Needed

Earliest Pick up Date

Pickup Details

Pick-upShip (own arrangements)Request Ship Quote

NOTE: If you need your items shipped, please provide your zip code. Payments must be made in-full before we will make arrangements to release product to driver/shipper.

Referred By:

Attach Required Files: Tax Certificate, IRS Status Letter, Promotional Collateral

Contact Information

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Product Purchase Form