Functionalmed

adding new life to years....

Materials Donation Form


Welcome to the 2008 functionalmed.org Materials Donation Page.


     Functionalmed.org accepts donations for building materials throughout the year. These products are utilized for maintenance and repair of housing for the elderly, low income, and disabled who do not have the ability to pay contractors to complete the work.

     Your tax deductable donation supports this important endeavor while providing vocational training for volunteer workers under the supervision of a general contractor. Please note the "fair market value" field on this form. Donated materials which are new should have a fair market value equal to the retail price. Used materials may have a considerably less fair market value for donation purposes. Consult you tax advisor if you have questions regarding the fair market value of your donated materials.

" * " indicates a required field.
* First Name
* Last Name
* Company Name
* Street Address
* City
* State
* Zip Code
Phone
* Email
* Fair Market Value

Please list or describe the materials you wish to donate: