City of Riverside COVID-19-related Donations Form

Do you have food, medical supplies (PPE), non-medical supplies, or other supplies you want to donate to the city? Fill out our online form to tell us what you'd like to donate and how you want to get it to us.

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* 1. Contact Information

Contact Name

Company Name

Telephone Number

Email Address

Website Address

Address

City

State

Zip

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

PPE/Healthcare equipment (N95 masks, surgical masks, gowns, face shields)

Food

Supplies (non medical)

Pick Up/Delivery Service

Lodging

Storage/Facilities

Other (please list below)

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* 3. Please describe the donation, include quantity of each item

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* 4. Can you transport the donation, if applicable?

Yes

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* 5. Please provide donor estimate of current value.

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* 6. What is the earliest date that you could provide transportation for the donation?

Date / Time

Date

Time

AM/PM

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* 7. Please briefly describe your company/organization.

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

Yes

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* 9. Do you currently do business with the City of Riverside

Yes

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* 10. If yes, please describe.

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

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* 12. Remarks: No goods or services were provided by the City in exchange for the donation?

Understand