Please Print this form out and return to us Via the fax or e-mail given above.
CONTACT INFORMATION (Please print or type)
Donor Name: __________________________________________________________________
Contact Name (If donor is a company): ______________________________________________
Address:______________________________________________________________________
City: ________________________________State: _______________Zip Code:____________
Phone: _______________________________ Fax: ___________________________
E-mail: __________________________________________________________
Web site: _________________________________________________________
DONATED ITEM (Please print or type)
_________________________________________________________________________________
Name of Item Donated: ______________________________________________________________
Manufacturer: ____________________ Model #: __________Cost or Value: ______________
($25 or higher)
*Complete Description of Item:_______________________________________________________________________________________________________________________________
*If your item contains multiple services or products please detail in description.
SERVICE OR GIFT CERTIFICATE INFORMATION REQUIREMENTS
If you are donating a gift certificate for a service, please include the following information in the certificate or letter.
•Name of product or service
•Description of what is included and what is excluded
•Name of person to contact for further information
•Name, address and full contact information for you or your company
•Instructions on how to redeem item
•Include any additional information such as a photo or description brochure as appropriate
•Date of expiration
***PLEASE FAX TO (760) 757-7814 OR E-MAIL TO INFO@TENDERLOVINGMERCY.COM**
