United Way of Metropolitan Atlanta / An AmericasMart Partner

DONATION INTAKE FORM

* Required Fields

* First Time Donation:

Yes No

* Material Handling:

Boxed (Packed) Unboxed (Loose)

Reason for Donation:

* First Contact Person:

Second Contact Person:

* Company Name:

* Street Address:

* City:

* State:

* Zip:

* Telephone:

Fax:

* Email:

* Requested Pick-up Date:

(mm / dd / yy)

* Requested Pick-up Time:

AM PM (00:00)

** An exact time will be communicated to you after submission to United Way.

Comments or Special Requests: