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* 1. Contact Name

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* 2. Organization Affiliation: If the donation is on behalf of an organization, please list the organization name.

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* 3. Email

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* 4. Phone Number

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* 5. Category of Donation

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* 6. Quantity: Please list the quantity of each item type.

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* 7. Open/Unopened: Please describe the status of the container.

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* 8. Manufacturer: Who manufactured the product(s)?

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* 9. Are you able to drop off the donation? w

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* 10. If not able to drop off the donation, please share the zip code where the donation can be picked up from.

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