Donation Request and Transfer Agreement

Donation Request and Transfer Agreement

Orlando Hackerspaces, Inc, 1355 Bennett Drive, Unit 105, Longwood, FL 32750
Name*

First NameLast Name
Item to be donated*
I, {name} (DONOR), acknowledge that my donation to Orlando Hackerspaces, Inc. (DBA FamiLAB) of {itemTo} is a permanent transferral of said item and that neither myself nor my representatives now or in the future have any claim to the aforementioned item. I acknowledge that the item is now the property of FamiLAB.

FamiLAB voluntarily accepts the above item “AS IS” and is solely responsible for any and all costs associated with the item. FamiLAB releases and discharges the Donor from any liability or responsibility for any injury (including death), and for any damage to or loss of property, however caused, that it may suffer as a result of or in connection with the item, including, without being limited to, injury, loss, or damage that may result from or arise out of or in connection with the negligent acts or omissions of members of FamiLAB.
E-mail*
example@example.com
Date*

MonthDayYear
Date
Signature of Donor *

Clear
A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE,1-800-435-7352 WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.

CONSUMER SERVICES REGISTRATION NUMBER CH50453
IRS EIN 27-3490023
Should be Empty: