ReSALE SHOP In-Kind Donation Form

Receipt of In-Kind Charitable Donation
Boost KC
6101 N Chestnut Ave Gladstone, MO 64119
(816) 453-6011
boostkc@boostkc.org
EIN #43-1307672

Boost KC is grateful for your non-monetary donation.
Donors do not receive any goods or services for their contribution.

Establishing a dollar amount of donated items or services is the exclusive
responsibility of the donor and/or an appraiser.

Boost KC reserves the right to determine the appropriate use of your
donation.

Name of Donor (Individual/Corporation)

First NameLast Name

Address (Optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email (Provide email address if you want a copy of the completed form)

YesNo

DONATIONS

Date of Donation (Required)*

Date

HouseholdClothingFurnitureMisc

List Household Items

Household Donation Value

List Clothing Items

Clothing Donation Value

List Furniture Items

Furniture Donation Value

Misc Items

Misc Items Value

Total Donation(s)

A copy of the completed form will be emailed to you.