Product Donation Agreement Kentucky Flood Relief 2009
Gifts In Kind International, the world’s leading charity in product philanthropy, is the link between donor companies and recipient charities. Every year, Gifts In Kind International and its community partners distribute nearly $750 million in donated products to a global network of 120,000 charities. In response to requests from local disaster relief agencies in the Louisville, KY area following the recent devastating flooding in the area, Gifts In Kind is requesting donations of cleaning supplies and equipment to aid in the relief effort. Just follow these steps to start the product donation process: 1. Complete this Product Donation Agreement. 2. Attach an inventory list. 3. Fax or email this agreement and your inventory list to Doyle Delph at Gifts In Kind International: 1-877-798-3192 or ddelph@giftsinkind.org A member of the donation management team will contact you immediately to make arrangements to coordinate your donation. 4. If you have any questions or would like to discuss the development of an ongoing giving program, call Barbara Florence at 1-703-299-7570. A. Donor Information and Agreement The company noted below promises to donate the inventory described in this agreement and on the accompanying inventory list to Gifts In Kind International.
___________________________________________
Company Name
__________________________________________
Contact Person/Title
__________________________________________________________________________________________
Street Address City
___________________________________________
State/Province, Zip/Postal Code
__________________________________________
Country
_________________________
Telephone
__________________________
Facsimile Title (print)
______________________________
E-mail
____________________________________________
Authorized company representative (print)
__________________________________________ __________________________________________
Date
____________________________________________
Signature
B. Donation Fair Market Value:
$USD _________________
or
$Canadian ___________________
(What the recipient charity would pay for this product in the normal marketplace. This information is used to provide your company’s tax documentation.)
C. Timeframe: When will your company be ready to make the donation? _____________________________ D. Donated Transportation: We request that donor’s provide shipping for disaster relief. Yes No E. Distribution: Where can this donation be distributed? U.S. only Outside U.S. only
Globally (no restrictions)
Specific countries (list)
_____
F. Description: Provide a brief description of the donation and attach an inventory list and additional product information such as Web site descriptions, catalogs, etc. __________________
________________________________________________________________________________
Important Notice: Gifts In Kind International encourages the donation of products classified for consumer use. If your donation does not fit this classification, please check here . If this box has been checked a representative from Gifts In Kind International’s donation development team will need to discuss and confirm our acceptance of the donation. Products that do not fit the consumer use classification which are shipped by the donor without prior approval by Gifts In Kind International will be returned to the donor and all charges incurred will be forwarded to the company for payment.
G. Hazardous Material: Please check if classified as Hazardous Materials Form with the Product Donation Agreement.
Please send MSDS
Please Note: If products are found to be rated HAZMAT when they arrive at our facility and you have not provided advance information by noting the products status as HAZMAT, then the product will not be accepted from the carrier.
H. Product Expiration Date (Time-Dating): Does the product you are donating have an expiration date or a time date? Yes No I. Quantity: ____________ Pieces/Eaches __________ Pallets __________ Cartons __________ __________ __________ Weight Cubic feet Truckloads
J. Type of Packaging: Shrinkwrap Loose Mixed/Assorted Unit Packs Other:
Pallets Single Unit Packs ____________________
K. Shipping Contact Information: If your donation’s point of origin is different than the address listed in Section A, complete this section. List a shipping contact, if different than the donor contact.
___________________________________________
Company Name Street Address State/Province, Zip/Postal Code City
__________________________________________
Contact Person/Title
__________________________________________________________________________________________ ___________________________________________ ________________________
Telephone
__________________________________________
Country
________________________
Facsimile
______________________________
E-mail
L. If this is your first donation with Gifts In Kind International, please complete: How did you learn about Gifts In Kind International?
Referred By Another Company (please list company name) Article in a publication (please list publication name) Web site (please list) Business Association (please list Association name) Received a Mailing From Gifts In Kind International Donated at a Tradeshow (please list Tradeshow) Other:
Donated goods will be distributed by Gifts In Kind International to charities serving the ill, needy and youth; used strictly for their charitable purposes; and will never be sold, traded or bartered, or used for raffles or auctions. Any goods received from Gifts In Kind International will not be used with the intention or knowledge that the products will be used to commit a terrorist act. As soon as your donation is received Gifts In Kind International will send you the documentation required for the appropriate tax deduction.
Gifts In Kind International Office Address – Do Not Ship To This Address, Call (703) 836-2121 for shipment instructions. 333 N. Fairfax Street Alexandria, VA 22314 U.S.A. 1-703-836-2121 (tel) 1-877-798-3192 (fax) www.giftsinkind.org