Customer request
for Tax Receipt of Equipment Donation
to Call to Protect
program of Donate a Phone

Date : _______________________________________________

Customers Name: ______________________________________

Address : _____________________________________________

City, State, Zip : _______________________________________

Phone Model : _________________________________________

Phone Value : _________________________________________

Customer understands that phones will be sent in periodically by Mainline Cellular to the Wireless Foundation based on donation volumes. Mainline Cellular is offering this service to its customers and benefits solely from the goodwill of its association with this charitable organization.

Upon receipt of the phones from Mainline Cellular the Wireless Foundation will issue a tax receipt to the customer directly at the address listed above. The Wireless Foundation indicates a 6 to 8 week delay for processing the phone and issuing a charitable receipt directly to the customer after its receipt.

Customers may verify shipment to the Wireless Foundation at any time at Mainline Cellular. Questions regarding tax receipt after proof of delivery to Wireless Foundation should be directed to 1-888-901 SAFE.

Thank you for your support.

_____________________________ Customers Signature indicates understanding of donation guidelines and that phone may also be sent directly to address listed below: