2022 In-Kind Donation Form | United Way of Washington County, MD

Donor Information

Donor Name

Donor Email

Donor Phone

Donor Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Date of receipt of contribution

Name/Title of staff member accepting contribution for United Way of Washington County, MD

Please list donated items:

Re-order	Item Description	Quantity	Retail Value (may estimate), $	Weight	Operations
	Item Description	Quantity	Retail Value (may estimate), $	Item weight

more items

In compliance with the IRS requirements regarding charitable contributions, United Way of Washington County, MD affirms that no goods or services have been provided by United Way of Washington County, MD in consideration, in whole or part, for this contribution.

Signature