Donations Request

Please fill out the following information to request equipment and/or supplies from Donate Delaware. Your request will be processed shortly. Thank you!

Requested By *

First

Last

Organization Name

Email *

Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Description and Quantity of Item(s) Requesting *

Date Requested *

Date Needed *

Requesting Delivery *

Custom Captcha *

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