U-Turn Donation Form

Gravel Road Home U-Turn Program

Please fill in the form below.
This agreement made between Gravel Road Home, a company that repurposes, refinishes, and reinvents furniture and home accessories (Retailer/Repurposer) and (Donor).
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
E-mail *
Charity Designation *
Charity Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Description of Donated Item *
Please donate 20% of the selling price of the donated item and repurposed item to my designated charity.

By clicking Submit, I hereby agree to all said terms of contract.
Should be Empty:

Gravel Road Home U-Turn Program