Donation Form

DONATION DESCRIPTION: Please include exact number of items, size, color, dates of service, expiration, number of people to be served (if appropriate) and other applicable details in your description.

OFFICE USE

Date Received ___________

Item# ___________________ Storage Location _________

PER EAST UP S E ID

NE

W

Donation Form

YO R C I T Y K

_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ________________________________________________________________ DONATION TYPE (check one): DELIVERY (check one):

__ Gift Certificate

__ Merchandise

RETAIL VALUE $____________

__ Sponsorship $____________

__ Donor will deliver before _________________ __ Solicitor will pick up by _________________ __ Merchandise or certificate attached __ Cash/Check sponsorship attached

NOTE: All items must be delivered to Wagner MS 167; all donated items become the property of Wagner MS 167

DONOR INFORMATION:

Individual / Business Name ___________________________________________________________________

Address _________________________________________________ Zip Code __________________________ Contact Person and Title (if applicable) ________________________________________________________

Phone Number ________________________________ Email ________________________________________

Donor Signature ___________________________________________________________ Date _____________ SOLICITOR INFORMATION:

Name _______________________________________________________________________________________

Address _______________________________________________________________ Zip Code_____________

Phone Number ____________________________ Email _____________________________________________ Child's Name & Class _________________________________________________________________________ Wagner MS 167 Parents Association is a 501c3 not-for-profit organization Your donation is tax deductible in accordance with federal law. Tax ID #13-3974003

Robert F. Wagner Middle School 220 East 76th Street New York, NY 10021 | 212 535 8610 | [email protected]