DONOR DETAILS  
 * Required fields 
* Email Address : 
* Password: 
[5 - 10 characters]
* Verify Password: 
[5 - 10 characters]
* First Name:   
* Last Name:   
* Address 1: 
Door/House # Street Name [include directional - N, SE etc.]
Address 2:  [Apt# 1234 or Unit A]
* City:   
* State / Zip: 
-
* Phone:  - -
Cross St. / Intersection: 
[max 25 Characters]
Preferrred Communication: 
1st:   2nd:   
 
  DONATION DETAILS  
* Pickup Dates:   
* Donation Items: [Click here for Full Listing]




* Donation items location: 
   
* Size of Donation:     
SMALLER    MEDIUM   
LARGER    X-LARGER   
Email Frequency: 
Route # on Postcard:   
*How did you hear 
about us? 
   
Comments / Directions: 
 
[max 25 characters]