Contribution Reporting Form

Contribution Reporting Form
Date of Gift *

Month Day Year
If the gift is for a council-hosted Special Fundraising Event, please select:
Please select the type of gift: *

Cash Check Physical Good(s) Professional Service Facility Rental
Gift Given to ____________________.

Girl Scouts—Dakota Horizons Council Service Unit Troop Individual Girl
Gift Made By *
Contact Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail
Please provide a description and value for each gift. *
Do you require an IRS Tax Receipt from Girl Scouts—Dakota Horizons?

YES NO
Donor Signature:
By typing your name into this box you are providing an electronic signature stating that you donated the above in-kind gift(s).
Notes to Donors:

Girl Scouts-Dakota Horizons gratefully acknowledges your contribution. Thank you for your generous support and for taking a moment to complete the above Contribution form. You are encouraged to consult with your tax adviser for current laws applicable to your generous in-kind donation(s).
Recipient Information
Receiving Party Signature *
By typing your name into this box you are providing an electronic signature stating that you received the above in-kind gift(s).
Phone Number *

Area Code Phone Number
E-mail
Girl Scouts—Dakota Horizons is a non-profit 501(c)3 organization (Tax ID 46-0250744).
Should be Empty:

Recipient Information