Upper Valley Materials Exchange

Directions: To finalize a tax-deductible transaction to a not-for-profit organization, the donor should print out, complete, and keep a copy of this form. The donor should make a copy available to the recipient of the materials upon request.

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Donor Information

Name of Donor (Please Print)

Signature of Donor

Phone Number Fax Number

Description and Value of Item(s) Donated
Include item description and dollar value.

 

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Recipient Information

Non-Profit Name

Phone Number Fax Number

Address:

501C3 Verification

Transaction Date:

Name of CEO/Principal/Designee Receiving materials:

(Signature)