GRACE Donations Offered
Date Offered
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Donor Full Name
First Name
Middle Name
Last Name
Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Total value for all donations
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Detail of Donations - Estimated value
Rows
Donated
Air Conditioner (window) $35
Bed Frame $15
Bookcase $40
Box Springs (double) $40
Box Springs (queen) $45
Box Springs (twin) $30
Bunk Bed Set w/Mattresses $150
Chair (Dining-Formal) @$75 each
Chair (kitchen) @ $25 each
Chair (living room side) $75
Chair (wood straight-backed) $20
Chair and Ottoman $100
Chest of Drawers (tall chest) $100
Crib with Mattress $50 - 100
Desk (Computer) $25-50
Long Dresser $100
Dryer $75
Love Seat $75
Mattress (twin) $50
Mattress (double) $50
Mattress (queen) $75
Mattress (king) $100
Microwave $25
Microwave Stand $25
Refrigerator $150
Recliner $100
Rug (Area 6x8) $25
Rug (area 8x10) $50
Sofa $100
Stove (kitchen electric) $100
Stove (kitchen gas) $100
Table (bedside) $35
Table (coffee) $50
Table (Dining-formal seats 6-8)$150
Table (kitchen seats 2-4) $100
Washer $100
Additional Notes
Below this line is for Office Staff
Date Receipt and Disclaimer Given
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: