HTML Preview Donationrequestform page number 1.
Donation Request Form for Not-For-Profit Organizations
1. Organization Name:
__________________________________________________________________
2. Address
___________________________________________________________
3. Contact Person ________________________ Job Title _______________________
4. Email Address ______________________________________________________
5. Phone Number
_______________________ Fax Number _____________________
6. Tax Exempt#
________________________________________________________
(Please provide a copy of your government exemption certificate with this form)
7. What programs and/or services does your organization provide?
______________________________________________
8. Approximately how many people take advantage of services offered?
_____________
9. Have you requested donations from NYU in the past? Yes No
10. Please list items your organization is currently requesting:
______________________________________________
11. Generally, NYU cannot provide delivery of donated goods. Can your organization arrange for pick-up?
Yes No
Instructions
• A "Waiver of Liability" form must be signed at the time items are removed.
• A copy of your Government Exempt Certificate must be filed with our office prior to removing
items.
• If you are submitting on-line, the "Waiver of Liability" form must be signed when picking up
items.
Asset Management
Administrative Services
105
East 17
th
Street, 2nd Floor
New York, NY 10003-21
05
Tel: (212) 998-1040
Fax: (866) 462-1422
Email:
asset.management@nyu.edu
Web Address: www.nyu.edu/asset