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United States Army Donations Program <br />Qualification Checklist for Donation of Combat Materiel <br />Veterans' Service Organizations <br />Please complete the following questionnaire and return this form with the required documents <br />outlined below: <br />Full- Name of Organization (ORG): <br />ORG Physical Address: <br />City: w ._ ,...mm. State: Zip Code: <br />Telephone Number: FAX Number: <br />ORG E-mail'Address: <br />ORG Mailing Address (if different than above): <br />City:u..... ..........,,., State: ... Zip Code: <br />ORG Representative (REP): w <br />Contact Information (If Different than above), Telephone Number: <br />Contact E-mail Address (If Different than above): <br />Name of Organization that owns the display site: <br />Address of Display site (if different from ORG): <br />City: <br />State: <br />Zip Code: <br />GPS Display Site Coordinates: <br />Type of Combat Equipment being requested (check only one): <br />[]Tracked Vehicle ❑ Towed Artillery ❑ Helicopter ❑ Any Combat Material <br />�....... <br />Size Restrictions, maximum Length....e...........-� and Width: Feet x Feet wwwww_aa _ <br />Do you currently possess combat equipment as static display? Yes No <br />�..n. ...............� <br />REP's Signature Date <br />1/3 <br />