GRACE Donations Offered
Date Offered
-
Month
-
Day
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.
Email
example@example.com
Detail of Donations - Estimated value
Donated
Air Conditioner (window) $25
Bed Frame $5
Bookcase $25
Box Springs (double or queen) $25
Box Springs (twin) $25
Bunk Bed Set w/Mattresses $100
Chair (Dining-Formal) @$75 each
Chair (kitchen) @ $25 each
Chair (livingroom side) $50
Chair (wood straight-backed) $15
Chair and Ottoman $75
Chest of Drawers (tall chest) $75
Computer $50
Crib with Mattress $50
Desk (Office) $20
Desk (Computer) $10
Dresser $75
Dryer $50
Entertainment Center/TV Stand $25
Love Seat $50
Mattress (double or queen) $25
Mattress (twin) $25
Mattress (king) $50
Microwave $20
Microwave Stand $25
Night Stand $25
Refrigerator $100
Recliner $75
Rug (Area 6x8) $15
Rug (area 8x10) $25
Sofa $50
Sofa (sleeper) $75
Stove (kitchen electric) $75
Stove (kitchen gas) $75
Table (bedside) $25
Table (coffee) $20
Table (Dining-formal)$100
Table (kitchen) $50
Table (living room end table) $20
Table (seats 2-4) $50
Table (seats 6) $75
TV (Large) $40
TV (Small) $10
TV Stand $25
Washer $50
Additional Notes
Below this line is for Office Staff
Date Receipt and Disclaimer Given
-
Month
-
Day
Year
Date
Submit
Should be Empty: