ACPA Research and Education Foundation Monetary & In-Kind Donation Form

All Donations are tax deductible and will benefit the ACPA Research and Education Foundation, a 501(c)3 organization that supports the development and funding of research and provides educational grants to foster knowledge of all types of pipe.

Donor's Information

Donor's Company*

Name of the company that makes the donation. If this is a personal donation, please state "personal" here.

Donor's Name*

First, Last

Donor's Phone*

xxx-xxx-xxxx

Donor's Email*

Donor's Address*

Where deduction tax letter is to be sent

Donor's City*

Donor's State*

Select or enter value

Donor's Zip Number*

Do you prefer this donation to be anonymous?

Select or enter value

Do you want to donate cash or something else?

Cash or Other*

Select or enter value

Amount of cash wishing to donate*

All cash donations will be invoiced by ACPA, however if you want to send a check prior to receiving the invoice please send a check to:

ACPA Research and Education Foundation

5605 N. MacArthur Blvd.

Irving, TX 75038 USA

972-894-2907

accounting@concretepipe.org

Cash donation may be used to purchase an item on consignment to be auctioned to benefit the Foundation. Your name will be recognized as a donor of the auction item unless you have select this donation to be anonymous.

Trip Information*

Please provide specific description of the trip (location, experience/sporting event, number of people, other amenities included, is airfare included, date limitations, etc.)

This information will be included in the auction website.

If "Other" please define

Please add here description of the item you are donating

(name of the donation, brief description, unique its unique characteristics)

This information will be included in the auction website to describe this item.

Amount Donated*

Please define the units of donated items. i.e. tons or number of loads for cement donations or pallets, shipments, boxes, volumes...etc for other items

Estimated Market Value ($)*

Plant/Terminal Location

Cement Type and Specification

Exclusions

Are there any exclusions to your donation? If so, please specify.

Shipping/Delivery included in Donation?

Yes

Other (provide comments below if needed)

Shipping/Delivery included in Donation - comment

Preferred Buyer's Information (if known)

The customer that you currently sell to that you would like to partner with to buy your donated items.

Buyer's Name

First, Last

Buyer's Phone

Buyer's Email

Who should the buyer(s) contact to claim your donated cement (if different from donor contact above)

Contact's Name

Contact's phone number

Contact's email

Date when donation must be delivered*

Drop here any pictures of the donated item?

These pictures will be included in the auction website.

Drag and drop files here or

Are you planning on attending the ACPA Annual Meeting?

Select or enter value

For more information on the Foundation, please contact the ACPA Foundation Fundraising Chair, Bill Adams at badams@concretepipe.org or 712-212-3344 or ACPA Foundation President Steve Hawkins at shawkins@concretepipe.org or 772-321-6880.

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