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									 From:                                                                                              Postage
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              H
           RUS                      Awake In America, Inc.
       NT/                          Attn: Operation Restore CPAP
     GE                             PO Box 51601
   UR                               Philadelphia, PA 19115-6601
       Hurricane Katrina
   Disaster Relief Donations


                                         Mailing Certificate

From:                                              Date Mailed: ______________      Agent Initials: ____________
Name:
                                                   Weight: ______________           Station: _________________
Address:
City                   State       Zip             Insured? Yes / No
                                                   Amount: $ __________
To:                                                Total Cost: $ ____________
Awake In America, Inc.
Attn: Operation Restore CPAP                       Be sure to keep this receipt            USPS Seal
                                                   for your tax records. Neither
PO Box 51601                                       the U.S. Postal Service, nor
Philadelphia, PA 19115-6601                        Awake In America, will be able
                                                   to issue a duplicate.




                    Operation Restore CPAP
                      Donation Inventory Worksheet
I am sending the following equipment to Awake In America, Inc., for its Hurricane Katrina “Operation
Restore CPAP “ disaster relief program. Please send me an itemized donation receipt.

Item Description                                                       Serial #
________________________________________________                       __________________________
________________________________________________                       __________________________
________________________________________________                       __________________________
________________________________________________                       __________________________
________________________________________________                       __________________________

								
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