Date: _________________

Name of Donor : __________________________________________ Signed: ________________________

Phone #: ___________________

Equipment was donated to Castaway Computers, Inc. from the above named corporation/individual/organization:

THIS EQUIPMENT IS NOW THE SOLE PROPERTY OF CASTAWAY COMPUTERS, INC. The equipment shall now be disposed of by any means deemed appropriate by Castaway in accordance with its mission and goals as stated in its By-laws.

Please sign in the space above and return it. Your signature indicates your acknowledgement and agreement that the said equipment has been donated, delivered, and/or picked up by Castaway Computers, Inc.

On behalf of CASTAWAY COMPUTERS, INC., Thank You for your donation.

By:_______________________________________

Title:_____________________________________