A Benefit to Support National Eating Disorders Association 603 Stewart Street, Suite 803, Seattle, WA 98101 Ph: 206-382-3587 * Fx: 206-829-8501* www.MyNEDA.org
IN KIND* CONTRIBUTION FORM NEDA Walk Location:_____________________________________ Date: _______________
DONOR INFORMATION Name:
Title:
Company: Street Address: City:
State:
Phone:
Email:
Web Address:
Other:
Zip:
ITEM INFO Item(s) to be donated. (Name and/or description):
Number Donated: ______________ Fair Market Value (each): $______________ Total Value: $______________ Special Notes (include any specs, dimensions, brand or manufacturer names, restrictions on use, deadlines, minimum bid required etc...):
Item (or gift certificate) enclosed
Please Recognize (Name or company)
Item will be ready to picked up by (Date) Or we will mail to the address below by (Date) [Coordinator Name, Address, City, State, Zip]
Signed__________________________________________________________________________ Date___________________ *An in kind contribution is a non-cash gift of goods or services that has a fair market value. The National Eating Disorders Association is a 501(c)3 not-for-profit organization – Federal Tax ID#: 13-3444882. Your contribution is tax-deductible to the full extent of the law. Please consult your tax advisor and/or IRS publications to verify deductibility.
National Eating Disorders Association 603 Stewart St, Suite 803, Seattle, WA 98101 *Ph: 206-382-3587 Fax: 206-829-8501 * www.myNEDA.org