Sign Up - Donation Kiosk

Thank you for showing interest in Donation Kiosk! Please fill out the form below and one of our Account Specialists will reach out to you for setting up your account.

Organization Details

Organization Name *

Organization Phone No *

Website / URL

Address *

Address Line 1

Address Line 2

City

State

Zip Code

501 (c)(3) Document *

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Authorized Signer

Designation *

Please enter your position at this organization.

Name *

First

Last

Email *

Phone No *

Photo ID *

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Please upload a copy of your drivers license for verification purposes.

By signing below, I agree that all information entered above is correct:

Signature

Website