United Way of
Rockland County

In-Kind Donations Form

Contact Information:

* First Name:        * Last Name:   

* Address:   

* City:        * State:        * Zip Code:   

* Contact Number:   

Email Address:   


Types of Items You Wish to Donate:




Value of Donation:   


Pickup Information:

* Pickup Address:   

* Pickup Date & Time:   





* Required information

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