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1. Contact Information (Required.)

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2. Type of Donation (Select at least one) (Required.)

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3. Please describe the donation, including capacity:

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4. Can you transport the donation, if applicable?

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5. If the donation is offered in a language other than English, please list the language(s).

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6. Is the donation being offered for a cost?

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7. Please provide any details related to the cost of the donation, if applicable.

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8. Is the donation worth more than $10,000? (Required.)

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9. What is the earliest date that you could provide the donation?

Date
Time

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10. Please briefly describe your company/organization.

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11. Do you/your organization have experience providing disaster relief?

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12. Do you currently do business with Los Angeles County?  (Required.)

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13. If yes, please describe. 

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14. Please provide your Los Angeles County Vendor Number, if applicable.

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15. Please provide any additional information regarding the donation that was not included above.

Thank you for your willingness to assist during this uncertain time. Someone will be in contact with you soon.

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