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Dr. Elsey's Litter Donation Request Application

To register your shelter for our program we require you to upload your tax determination form (501c3) and a noncash charitable contributions tax form (8283), in addition to completing the application below.

"*" indicates required fields

Shelter/Rescue information

Primary Account Contact*
Important Shelter Program Update

Click on above link to learn about our shelter donation program update!

Physical Address of Shelter/Rescue*
Max. file size: 1 GB.
Note: If you are unable to upload the proper form due to an error, please upload a blank document and email the proper forms to support@drelseys.com
Required 8283 Tax Form

Please download and fill out ONLY Section A. 1a. and Section V on page 2 of Tax Form 8283 (name, address, signature, etc.).

Attach completed form to application under 8283 Tax Form.

Max. file size: 1 GB.
Note: If you are unable to upload the proper form due to an error, please upload a blank document and email the proper forms to support@drelseys.com
Max. file size: 1 GB.
Note: If you are unable to upload the entire form to the first attachment please attach the second page here.

Information for Donation Delivery

DOCK ACCESS AND FORKLIFT ARE REQUIRED FOR DELIVERY.
*If your location does not have a dock to receive your shipment, please coordinate with a local business with one (such as PetSmart or Home Depot)*
Commercial DELIVERY Address*
*If your location does not have a dock to receive your shipment, please coordinate with a local business with one (such as PetSmart or Home Depot)*
Primary Contact Name for Delivery*
Secondary Contact Name for Delivery*
In case we are unable to get a hold of primary for delivery
Preferred days, time, other
Will the contact name and phone listed above be able to schedule an appointment with delivery driver?*
Do you have a pallet jack or forklift?*
*A Pallet Jack or a forklift is a requirement for delivery!
Do you have access to a Dock to Dock delivery?*
*Dock Access is a requirement for delivery! Dock height MUST be between 48-52 inches.
Donations can be requested every 3 months (no exceptions).
MM slash DD slash YYYY
Donation orders contain:
  • 1 Pallet (49 bags) of Ultra Litter 40lb Bags (shelter use ONLY)
    • and
  • 1 Pallet (90 boxes) of Cat Attract 20lb Boxes (Adopting Family to receive 1 free box with Cat Adoption)
Please acknowledge by initialing here:

Signature

By signing below, I understand and accept all terms of the program below:

Additional Program Notes:

  1. New litter donations can be requested every three months.
  2. No product or size substitutions are available. No exceptions.
  3. LITTER IS NOT FOR RESALE! To maintain the integrity of our Shelter Donation Program, products must be used only as outlined above. Misuse of the program will result in immediate removal from said program and, if necessary, notification to the appropriate tax governing authorities.
Signed by*