Pankhudi's Sahayata Colletion Drive For Flood Relief 2009

Please share the collection details and the contacts of the good-hearted donors for the flood relief.
This form can also be used as a pledge form-wherein the donor can fill in the details of items himself/herself.

Thanks for your bit for the relief of the flood sufferers!

* Required

Donor Details

Please enter the identity details of the Donors below:

Name of the donor * In case of organization, please enter the name of the organization and the contact person from that organization.

Contact Number * This is mandatory.

Email * Provide your email address.

Address of the donor * Complete Mailing address of the donor.

Collection Details

Please enter all items contributed by the donor. (or the pledge by the donor!)

Dry Ration Please specify approx Qty. ( in kgs / count / no of bags / etc) Example: 2 kgs rice / 3 small bags of wheat flour / 1 container oil / etc

Clothing (Properly cleaned) Please specify approx Qty. (No of clothes / No of polythene bags / etc)

Water purifier tablets Please specify approx Qty.

Cooking utensils Please specify approx Qty. (Count / No of bags)

Others (Feeding Bottles (for children) / Plastic sheets/Mosquito-Nets/Polythene-Bags / Matchboxes / Candles) Please specify Iteam details with approx Qty.

Remarks / Feedback Provide your remarks / feedback / suggestions