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First name
*
Last name
*
Email
*
Street address
*
Street address 2
City
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State/Region
*
Postal code
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Phone number
*
Company name
Job title
Check this box if Donor info is different than above
Itemized Description of Donated Item(s) or Service(s)
Estimated Fair Market Value
*
Determined by Donor
When would you like to drop off your donation?
Month
/
Day
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Year
If you are donating these items directly to one of our Playspace Programs, have you been in contact with a Playspace Program staff member regarding your donation and/or drop off coordination?
Please Select
Yes
No
Not a Playspace Donation
Donor E-Signature
Please type your name to verify that the estimated fair market value was provided by the donor.
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