Astegos Membership Application 2024

Astegos Membership Application 2024
Are you signing up as a teacher?*

YesNo
Teacher Membership Application 2024

Please review application requirements carefully. Recipients must submit required documentation with a completed and signed agreement for approval by Astegos, Inc (Astegos.org).

All recipients agree to adhere to the following guidelines set by Astegos, Inc, Good360, the Internal Revenue Service, and/or retail donation partners. It is critically important that all organizations accepting products from Astegos, Inc abide by the following:

The undersigned provides proof teacher status. An employee badge or other documentation is required to source products from the Astegos.org Community Warehouse.

The undersigned and all recipients therein guarantee that received goods will be used solely for the care of the ill, needy or youth (as those terms are defined in applicable U.S. Treasury regulations).

The undersigned makes certain that the use of received goods will be related to the purpose of the school that makes them tax exempt.

The undersigned ensures received goods will not be transferred (or attempted to be transferred) in exchange for money, property or other services.

The organization agrees to provide complete substantiation of its distribution of all received product donations to Astegos, Inc, Good360, the Internal Revenue Service, and/or retail donation partners, in a reasonable time, upon request.

The undersigned understands that anyone using donated products for purposes other than those intended can be removed immediately from the program.

You understand and agree that any Donated Goods you may receive from Astegos will be received by you in “as-is” condition and that Astegos makes no warranty, covenant or representation, expressed or implied, regarding the Donated Goods, including without limitation, their design or condition or fitness for any particular purpose. Astegos shall not be liable for any direct or consequential damages or losses suffered or incurred by you or a third party as a result of the use or consumption of the Donated Goods.

You agree to indemnify and hold harmless Astegos, its donors, its affiliates, and each of its respective officers, directors, employees, agents, counsels, successors, and assigns from and against any loss, cost, damage, expense, or liabilities (including reasonable attorneys’ fees) incurred in connection with any and all claims, including third party claims, that result from or relate to Astegos’ negligence or willful misconduct, or the manufacturing of the products donated by Astegos hereunder. Gift Cards for our Community Warehouse have no cash value.

You agree to receive electronic communication from Astegos including emails, phone calls, and text messages.
School, Nonprofit, & Church Membership Application 2024

Please review application requirements carefully. Recipients must submit all required documentation with a completed and signed agreement for approval by Astegos, Inc (Astegos.org).

All recipients agree to adhere to the following guidelines set by Astegos, Inc, Good360, the Internal Revenue Service, and/or retail donation partners. It is critically important that all organizations accepting products from Astegos, Inc abide by the following:

The undersigned provides proof of not-for-profit status as described in Section 501(c)(3) of the Federal Internal Revenue Code or a recognized U.S. Indian reservation; and/or is exempt under Section 501(c)(3); Public Charity) and is not a private foundation (other than an operating foundation described in Section 4942(j)(3)).

The undersigned organization and all recipients therein guarantee that received goods will be used solely for the care of the ill, needy or infants (as those terms are defined in applicable U.S. Treasury regulations).

The undersigned organization makes certain that the use of received goods will be related to the purpose of the organization that makes it tax exempt.

The undersigned organization ensures received goods will not be transferred (or attempted to be transferred) by the organization in exchange for money, property or other services.

The undersigned organization agrees to maintain adequate books and records of received donations as required by applicable tax regulations and to make such records available upon request to Astegos, Inc, Good360, the Internal Revenue Service, and/or retail donation partners. The organization agrees to provide complete substantiation of its distribution of all received product donations to Astegos, Inc, Good360, the Internal Revenue Service, and/or retail donation partners.

The undersigned organization understands that any organization using donated products for purposes other than those intended will be removed immediately from the program and legal action will be taken.

You understand and agree that any Donated Goods you may receive from Astegos will be received by you in “as-is” condition and that Astegos makes no warranty, covenant or representation, expressed or implied, regarding the Donated Goods, including without limitation, their design or condition or fitness for any particular purpose. Astegos shall not be liable for any direct or consequential damages or losses suffered or incurred by you or a third party as a result of the use or consumption of the Donated Goods.

You agree to indemnify and hold harmless Astegos, its donors, its affiliates, and each of its respective officers, directors, employees, agents, counsels, successors, and assigns from and against any loss, cost, damage, expense, or liabilities (including reasonable attorneys’ fees) incurred in connection with any and all claims, including third party claims, that result from or relate to Astegos’ negligence or willful misconduct, or the manufacturing of the products donated by Astegos hereunder. Gift Cards for our Community Warehouse have no cash value.

You agree to receive electronic communication from Astegos including emails, phone calls, and text messages.
Name*

First NameLast Name
School Name*
School District*
Organization Name*
Organization Type*

SchoolChurchNonprofit (501(c)(3) Public Charity)
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Website
How did you hear about Astegos Community Warehouse? (Check all that apply)*

Another TeacherSocial Media (Facebook, Instagram)Community EventsHome School Co-opPostcardCompany WebsiteCompany referralNews MediaNonprofit ReferralConferenceChildren’s ItemsInternet researchOther
Basic Needs Assessment - What kind of items are you looking for?*

Building MaterialsChildren’s ItemsClothing and AccessoriesComputer SoftwareHome GoodsOffice ProductsPersonal Care ProductsSchool SuppliesDecorationsToolsOther
Organization Service Areas*

Adult EducationAffordable HousingAdvocacyArts/CulturalChildcare/YouthCommunity DevelopmentDisaster ServicesDrug Abuse/Prevention/TreatmentDisabledElderlyEmploymentEnvironment/ConservationFamilyFinancial/Legal AssistanceHealth Care/Mental Health AssistanceHuman RightsHungerHomelessnessInternational AssistanceK-12 Education/LiteracyTechnology AccessVolunteer CoordinationOther
Does your organization operate a thrift store? (will not disqualify you)*

YesNo
Does your organization charge a fee for services provided? (will not disqualify you)*

YesNoSometimes
EIN #*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
501c3 Letter of Determination (if you do not have this at hand, we can look this up online and add it to your file later, please let us know it needs to be added when you come down)*

Cancelof
My organization raises less than $50,000 annually*

YesNo
Please list the names of anyone from your organization who you would like to be able to access the Astegos Community Warehouse. (More names can be added at a later time)
Title of Authorized Representative Completing this form*
What Grade(s) do you teach?*

Pre-SchoolKindergarden1st2nd3rd4th5th6th7th8th9th10th11th12thSpecial EducationOther
How many students are you teaching this school year?*
Are you a Homeschool teacher?*
Upload a copy of your Teacher/School ID or ignore if Homeschool teacher with no ID*

Cancelof
Teacher Signature.

By signing below you affirm that the information you have provided on this application is accurate to the best of your knowledge, and you agree to follow the guidelines above.
Organization Authorized Representative Signature.

By signing below you affirm that you have the authority to bind your organization to this agreement, that the information you have provided on this application is accurate to the best of your knowledge, and you agree to follow the guidelines above.
Signature*

Clear
Should be Empty: