In-Kind Donation Form

Salutation

First Name

Last Name

Work Phone (Must be unique)

Mobile Phone (Must be unique)

Region of Interest

Donor Type

Company/Organization Name

Street Address

City

State

Zip Code

Donation Information

Type of In-Kind Donation

Subtype of Gifts for Patients/Families

Subtype of Event Services

Subtype of Services

Date of Delivery OR Date When Opportunity Will Be Provided

In-Kind Donation Related To

Which Fundraising Event

Solicitor, If Any (Name of the Dragonfly Representative Who Initially Contacted You)

Description

Estimated Total Value

Delivery Information

I will hand deliver or mail my donationI will need my donation to be picked upI have already provided a Dragonfly Representative with the donation:I am unable to donate an item, but please accept my cash donation.**

Name of Dragonfly Representative Who Accepted Donation

*** To make a monetary donation, please visit Dragonfly.org or text TDF to 91999. You can also mail your donation to The Dragonfly Foundation, 506 Oak Street, Cincinnati, OH 45219.

Thank you for your support!

[email protected]

513/494-6474

For more information visit: Dragonfly.org

The Dragonfly Foundation is a 501(c)(3) non-profit organization dedicated to bringing comfort and joy to kids and young adults enduring cancer and bone marrow transplants. Donations to The Dragonfly Foundation, a qualified organization under IRS regulations, are deductible as allowable by law. All donations will be acknowledged in writing, including the Dragonfly’s tax identification number for your records. Contact your tax advisor for advice concerning the deductibility of your donation.

The Dragonfly Foundation | 506 Oak St. | Cincinnati, OH 45219

513-494-6474 | [email protected]

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In-Kind Donation Form

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