Computer and Small Office

ELECTRONICS DONATION FORM

Please fill out and bring one copy with your donation 

MAKE 2 COPIES if you would like a receipt

Chesterfield Mall ARTropolis

Second Saturday of Every month

Please no drop offs prior to events

10:00AM to Noon

Please Call 24 hours before Delivery

to confirm

636-227-7095

Date______________________________________

Name______________________________________

Address___________________________________

__________________________________________

___________________________________________

Phone_____________________________________

EMAIL_______________________________________

COMPUTER/ELECTRONIC EQUIPMENT $8.00 each to destory Hard Drive

# MONITORS_________________ $20.00 Each

# KEY BOARD(S)________________

#MOUSE/MICE___________________

CELL PHONE____________________

#CPU(S)_________________________$10.00 Each

OTHER__________________________Please FEEL FREE TO call ahead to verify your SMALL electronics $10.00 Each

10 pounds of Free material will be donated to a school or youth organization for each monitor/CPU and small electronics we receive.  You can designate a registered school or organization.  Please have  a school representative call to be included on our donation list.

Schools and Youth Programs

Columbia School, City of St. Louis________                                River City Kids_______________

Edgewood Children Center ______________                               Geggie Elementary____________

Simon Says Day Care______________                                      Little School and Gym__________

Masterpeace Studios_______________                                      Gifted Resource Council__________

Bristol ECE Webster Groves, MO____________                         Elm Point ECC______________

Hospitals

Children's______________________   Shriner's______________________ Cardinal Glennon_________________

Designate a school, teacher, artist or program_______________________________________

Donor Signature_________________________  SLTRC Representative_________________________

Comments_________________________________________________________________________________