Your name:
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Brief description of item you wish to donate
*
How would you rate the item's condition?
*
Excellent
Good
Fair
Poor
Please upload photo 1 of your item.
*
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Please upload 1 photo
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of
Please upload photo 2 of your item.
*
Browse Files
Please upload 1 photo.
Cancel
of
You may upload more photos here.
Browse Files
Please upload photo
Cancel
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You may upload more photos here.
Browse Files
Please upload photo
Cancel
of
Please verify that you have attached at least 2 photographs of the item you wish to donate.
*
Yes, I have provided photos.
Current location of item
*
Where has the item been stored?
*
How did this item come into your possession?
*
Are you the legal owner of the item and do you have the authority to donate it?
*
Yes
No
Other
If the item is accepted by FDM / AH, are you permanently relinquishing all rights to the item, including proceeds if the item needs to be sold?
*
Yes
No
History of item
*
Does the item have any supporting documentation?
*
Yes
No
Other
If the item is accepted by FDM / AH, will it be delivered? If it needs to be picked up, there may be a fee involved.
*
Yes
No.
Other
Any further information you wish to provide?
Today's Date
-
Month
-
Day
Year
Date
Please verify that you are human
*
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