Donate an Item

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Fields marked * require an entry.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Item Restrictions & Specifications:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

If in response to a specific request, who made the request?

Is a physical item or certificate provided by the donor/solicitor?*

Yes

No

If yes, how will the item be delivered to Imagine Housing?

Are you willing to donate the item twice?*

Yes

No

Other Comments?

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*

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