Donation Information Form

Please enter the information for the donated item you have received for the D200 Foundation. * required field

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Select the trustee/board member from the list that received the donation*:

Donor Details:

Company Name*:

Contact Name*:

Address 1*:

Address 2:

City*: State*: Zip Code*:

Contact E-mail*:

Phone Number*: - -

Estimated Value*:$

Additional Comments:

Please enter the text from the image*: