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DONATION COMMITMENT FORM
Please submit this form with your donation. Shelf stable and freezer donations can be dropped off at the Columbiana County Mental Health and Recovery Services Board office, 27 Vista Drive, Lisbon, from 8 a.m. to 4 p.m. Monday through Friday until November 3rd.
Please write in the amount you are donating next to the item listed. For example:
Canned Green Beans ___12_______
NAME: ______________________________________ Phone Number: ____________________
ORGANIZATION: ________________________________________________________________
FOOD DONATIONS
Ham ________
Instant Mashed Potatoes _________
Butter Pats ________
Green Beans ________
Instant Stuffing ________
Gravy ________
Pre-Cooked Rolls ________
Pre-cooked Dessert ________
Gallon Beverage ________
Large Styrofoam containers for to-go meals ________
HYGIENE ITEMS
Toothbrush ________
Toothpaste ________
Shampoo ________
Soap ________
Deodorant ________
Other ________
RESOURCE TABLE
Our organization would like to set up a resource table
Salem Location ________ East Liverpool Location ________
Resource items to be distributed: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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