Non-Cash/Gift-In-Kind Form
A c h i e v i n g t h e D r e A m
Donor Information
Donor Name(s): _____________________________________________________________________________________
Address: ____________________________________________________________________________________________
City: _________________________________________ State:______________ ZIP: ______________________________
Phone: _________________________ Cell: ________________________ Email: _________________________________
Donation
I approve the use of my name in a published list of donors. Do not use my name in a published list of donors.
Description of Item (please be as specific as possible or attach detailed inventory):
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Estimated Value (to be provided by donor): $____________
Please check one: Donor statement of value Appraisal attached Receipt attached
______________________________________________________________________ ________________________________
Donor(s) Signature(s) Date
Gift Received By
Faculty/Staff Name: __________________________________________________________________________________
Department:_______________________________________________ Extension: _______________________________
The College of the Mainland Foundation will provide a receipt and a thank you note to the donor.
Please return to: College of the Mainland Foundation, 1200 Amburn Rd., Texas City, TX 77591 or fax to (409) 933-8041.
For more information, please call (409) 933-8508.
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