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 NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Charity Designation*
Charity Address*

Street Address

Street Address Line 2

CityState / 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