Organization Name *

Organization Address *

City *

State * Example: WA

Zip Code *

Primary Contact First Name *

Primary Contact Last Name *

Primary Contact Phone # * i.e. 206-555-5555

Primary Contact Title *

Tribe/Executive/Agency Information

Tribe Name or Chief Executive Name *

Tribe/Executive/Agency Lead Email *

Tribe Information or Mission Statement *

County or Counties of Service *

Number of Clients Served Per Month *

Fax

Website *

COVID-19 Info

Number of Clients served per month for COVID-19 *

Counties or Area of Service for COVID-19 *

How Did You Hear About Us?

EIN / School Number / Agency ID Number *

990 or Financials File Upload *

State Registration Form Upload *

501C3 File Upload *

Donation Acceptance Agreements

Donation Acceptance Agreement Details This section must be read and signed by all authorized members and an authorized representative of the organization. TMWG and its registered nonprofit partners take their responsibility to serve those in need very seriously. Organizations failing to adhere to the following guidelines will be prohibited from participating in programs administered by TMWG and, if appropriate, legal action will be taken.

By accepting products and services from The Moore Wright Group (TMWG), you certify that: 1. It is an organization described in Section 501(c)(3) of the Federal Internal Revenue Code or a recognized U.S. Indian reservation; and/or is exempt under Section 501(c)(3); and is not a private foundation (other than an operating foundation described in Section 4942(j)(3)).

2. The goods will be used for the care of the ill, needy or youth/children/infants and must be given away free of charge (as those terms are defined in applicable U.S. Treasury regulations). In addition, the goods can be used by your office for administrative purposes. The use of goods will be related to the purpose of the organization that makes it tax exempt.

3. The geographic scope of services must be within your local community. Items cannot be shipped outside of the U.S. without advanced written permission.

4. The use of the goods does not authorize the organization to sell, trade, barter or otherwise transfer the items for money, property or services in order to operate or related to the operation of its offices or to pay any administrative fee to The Moore Wright Group (TMWG) or any shipping charges related to the procurement of the goods.

5. Goods cannot be transferred to other nonprofit organizations or groups without advance written permission from The Moore Wright Group (TMWG). Please note that if written approval is granted by The Moore Wright Group (TMWG), charities receiving the goods must be registered directly with The Moore Wright Group (TMWG).

6. Goods cannot be used for fundraisers, raffles or auctions; given to volunteers or staff members; or sold in retail stores, on web sites, in flea markets, or in any other manner.

7. The organization agrees to maintain adequate books and records of these items as required by applicable tax regulations and to make such records available upon request to The Moore Wright Group (TMWG) and/or the Internal Revenue Service. The organization agrees to provide complete substantiation of its distribution of all product donations to the Internal Revenue Service and the Moore Wright Group (TMWG) promptly upon request.

8. The organization must have and adhere to a nondiscrimination policy such as “No person shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination in any program or activity available on the basis of race, color, sex, religion, creed, political belief, age, national origin, linguistic and language difference, sexual orientation, socioeconomic status, height, weight, marital or familial status, or disability.”

9. You agree that this restriction may be enforced by a court entering equitable relief including, but not limited to, injunctive relief. The Moore Wright Group (TMWG) reserves the right to limit, restrict or terminate any order of donations requested by your organization at any time without cause and without notice.

10. Donations must be stored at a business location and not a personal residence.

Breach of your organization’s obligations as stated above will entitle TMWG to rescind this agreement and recover any and all donated goods. In this connection, your organization agrees that the remedy of monetary damages is not exclusive and is inadequate and that TMWG will be immediately and irreparably damaged by any such breach. In such an event, your organization consents to the imposition of a constructive trust on any and all such goods in favor of TMWG and further consents to a temporary, preliminary and permanent injunction in favor of TMWG, forbidding your organization from making any disposition of the goods and requiring your organization to return immediately all such goods to TMWG, as it directs. Your organization agrees to pay TMWG in full for any expenses, including legal fees, incurred in connection with investigating, preparing for, litigating, or settling any action brought under any breach of an obligation stated above.

Do you agree to the terms above?

Agreement Required to Receive Donations * Yes, I agree No, I do NOT agree