Donate Form

This is the equipment donations form. Please fill it out with as much information on each piece that you have. If you have more than 5 pieces, please call us directly (or if you want to you can submit the contact form multiple times)

Step 1

(1 out of 4)

First Name:
Last Name:
Organization:
Address:
Address CONT:
City:
Zip Code:	(5 digits)
State:
Phone:
Fax:
Email:
Comments:	Enter comments here!

*To Continue, scroll up and select the next Step*

Step 2

Continued...(2 out of 4)

How long will equipment be available?:	1) 2) 3) 4) 5)
How old is it?:	1) 2) 3) 4) 5)
Was it purchased new or used? When?:	1) 2) 3) 4) 5)
Is it paid for?:	1) 2) 3) 4) 5)
Where was the equipment used?:	1) 2) 3) 4) 5)
For how long?:	1) 2) 3) 4) 5)
Is it still being used?:	1) 2) 3) 4) 5)

*To Continue, scroll up and select the next Step*

Step 3

Continued...(3 out of 4)

How many hours a day?:	1) 2) 3) 4) 5)
Is the equipment in storage?:	1) 2) 3) 4) 5)
How long has it been there?:	1) 2) 3) 4) 5)
Is the equipment in working order?:	1) 2) 3) 4) 5)
Brand Name:	1) 2) 3) 4) 5)
Model Number:	1) 2) 3) 4) 5)
Serial number, if any:	1) 2) 3) 4) 5)

*To Continue, scroll up and select the next Step*

Step 4

Continued...(4 out of 4)

Year Purchased:	1) 2) 3) 4) 5)
Bought New or Used:	1) 2) 3) 4) 5)
Used in what kind of facility? / How many hours a day?:	1) 2) 3) 4) 5)
Was it Maintained?:	1) 2) 3) 4) 5)
Repair History:	1) 2) 3) 4) 5)

NOTE: Please be aware that we can not take all equipment. Sometimes the equipment can not be repaired, or is not in demand. We reserve the right to accept as much or as little of your kind donations as we have need for.