We Love Leftovers Profile Application
Organization Name
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Phone Number

###		-
###		-
####
Website
Contact Person Who Will Coordinate Donations:
Prefix
First
Last
Suffix
Phone Number

###		-
###		-
####
Email
Contact Person Who Will Update Profile (if different from above)
Prefix
First
Last
Suffix
Phone Number

###		-
###		-
####
Email
Organization's Mission Statement (1 sentence)
Donations That Will Help Your Organization (check all that apply)
 Appliances 
 Art 
 Art Supplies 
 Books 
 Building Materials 
 Cleaning Supplies 
 Clothing 
 Electronics 
 Expendables 
 Fabric 
 Food 
 Furniture 
 Lighting Equipment 
 Musical Instruments 
 Office Supplies 
 Paint & Supplies 
 School Supplies 
 Sound Equipment 
 Sports Equipment 
 Storage Containers 
 Toiletries 
 Toys 
Other Donations (don't be shy)
Can You Pick Up Donations?
 Yes 
 No 
If Yes, By What Means of Transportation?
 Car 
 Cargo Van 
 Cube Truck 
Other Form Of Transportation
Can Productions Drop Off Donations?
 Yes 
 No 
What Days & Hours?
Donation Drop Off Address (if different from above)
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
What type of organization are you?
Additional Information

Page 2

The following information is for our evaluation purposes and may be shared with the public if we chose to highlight your organization.
How Do You Make Use Of The Donations You Receive?
Past Accomplishments (please include dates) :
Future Goals:
How Did You Hear About We Love Leftovers?
Would You Like To Receive Email Updates About Events Or Available Donations?
 Yes 
 No Thanks 

Agreement

In order to create your profile you must submit information that is accurate. By submitting this form you are agreeing to keep your organization's profile updated all year round and will participate in our bi-annual mandatory check-ins. We Love Leftovers cannot work without your cooperation in this area, therefore we hold the right to terminate your profile if we feel your information is inaccurate. We hope never to have to do so, so please keep us informed!
Do You Agree to the Terms Listed Above?
 Yes 
 No 
Image Verification
captcha
Please enter the text from the image:
[Refresh Image] [What's This?]
Powered byEMF Online Form Builder
Report Abuse