Service Territory Map
Schools & Educ.
In-Kind Donations of Excess Property Form
Please read our
(pdf) before filling out the application.
Section 1 of 2
= required information)
Legal name of organization:
Are you affiliated with a state or national organization?
Is your location served by us?
In which area does your organization serve?
New York-Western (Buffalo, Olean, Dunkirk area)
New York-Central (Syracuse, Cortland, Oswego area)
New York-Northern (Watertown, Potsdam area)
New York-Mohawk Valley (Utica, Rome area)
New York-Capital/Eastern (Albany, Glensfalls area)
Does your organization receive United Way funding?
Is your organization an IRS 501 (c)(3) organization?
What is your Taxpayer ID number?
How do you define your services?
Health & Human Services
Section 2 of 2
Decription and Quantity of items you are requesting:
Description of item:
Quantity of item:
How will these items benefit your organization?
Best time to call to schedule pick-up?