Jacob's House Inc. In-kind Donation Form

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Jacob’s House is a private, non-profit and is tax exempt under Section 501(c) (3) of the Internal Revenue Code. Jacob’s House is dedicated to helping family members who have a loved one hospitalized due to a traumatic medical life event in the Temecula Valley.

TAX RECORD FORM: Federal law provides that all values of donated household good’s received by a Jacob’s House must be assigned by the donor. Please keep this form as your donation record. For more information please visit jacobshousetemecula.org. Our Federal Identification Number (EIN) is 26-1183832. You will receive a copy of this form to your e-mail listed below.

Email *

First Name *

Last Name *

Organization *

NCL (Meals)

NCL (General)

No Organization

Other:

Donor Street Address

City

Temecula

Murrieta

Wildomar

Menifee

Other:

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State *

Other:

Zip Code

Items Donated *

Quantity *

Estimated Cost *

Is this a food donation? *

Yes

What is the approximate weight of the food?

A copy of your responses will be emailed to the address you provided.

Submit

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