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Phone *

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Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are items...? *

Shelf Stable

Refrigerated

Frozen

Preferred Date and Time of Pickup *

MM

DD

YYYY

*

Hour

Minute

Second

AM PM

Pickup address same as mailing address? *

Yes

No

*

I affirm that all donated food is safe for consumption and has been stored properly.

I understand that this donation is non-refundable and that the nonprofit is not responsible for tax valuation of goods.

I would like to receive a donation receipt for tax purposes.