_______________________________________________________________________________________________
Materials/Equipment Donation Form
Item(s) Donated __________________________________________ Model/Serial No. ___________________
Description (Attach additional pages if needed)
Estimated Value at Time of Purchase $______________ Estimated Value at Time of Donation $_______________
Company/Person Making Donation ________________________________________ Phone _____________________
Address __________________________________________________________________________________________
Phone ____________________________ Title of Company Representative (if applicable) _______________________
Donor Signature _______________________________________ Printed Name ______________________________
For Vehicle Donation: Donors Identification No. ______________________
Received by ____________________________________ Date Received ______________________________
To be completed by Durham Tech Foundation Representative:
Use and Location of Equipment
Estimated Cost of Installation $______________ Estimated Cost to Place in Usable Condition $_______________
Final Disposition _________________________________________________________________________________
Date ____________________ Authorized by ________________________________________
Donation Acknowledged by ___________________________________ Acknowledgment sent on _____________
Notes __________________________________________________________________________________________
Revised 10/2016
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