In the box below, using no more than three clear and concise sentences, briefly describe your mission statement. A mission statement defines the core purpose of your organization, or why it exists. Do not place any other messages in this box or your application will not be approved.

Information submitted will be reviewed for authenticity. Your organization's webpage is required to use our services and will be verified for availability and content. Your page must contain complete contact information and clearly reflect your nonprofit status. Place ONE valid webpage address (URL) in the box below.

All information submitted above will be forwarded to each donor whenever you request equipment. Review your information now for appropriate capitalization, punctuation, and spelling errors. You will have no opportunity to edit your information once you submit this form. Carelessness now will reflect upon your organization in the future.

Upon sending this application, you will receive immediate email confirmation of your submission. Your application will be reviewed and you will be notified upon approval. If you do not receive an immediate reply, your email address failed and your application is void.

ONE valid email address is required.

Please verify your address for accuracy or your submission will fail

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