Tourette Syndrome Association of
phone:
281-238-8096 fax: 281-238-0468
toll free: 1-866-896-8484
Item Donation Form
Thank you for your donation to TSA of Texas. Please
complete the necessary information below.
This information will be used to send you a tax letter for your files.
Your Name: _____________________________________ Phone: _____________________
Company Name: _____________________________________________________________________
Address:
City:______________________________ State: ______________ Zip: _____________________
Email address: __________________________________________
Description of Item:
Item or Certificate Value: ________________________
please note:
According to IRS regulations,
establishing a dollar value on donated items
is the exclusive responsibiity of the donor.
Donor’s
Signature: Date:
Received
by: Date:
Please mail item or gift certificate to: TSA of
Or email mailto:tourettetexas@aol.com to arrange pick-up.
The Tourette Syndrome Association of
Texas is a 501(c)(3) organization, qualified to receive charitable
contributions in accordance with IRS regulations.
