Musicopia

Instrument Donation Form

Please complete all of the information below and ensure that this form stays with your instrument.

HIDDEN

Anonymous Bucket AccountID

TEMP Bucket AccountID

Campaign ID

Please make my donation anonymous

First Name

Last Name

Business Name

Phone

*You will be added to our e-newsletter list. You may choose to unsubscribe at any time directly from the newsletter.

Address Line 1

Address Line 2

City

State

Postal Code

Where did you hear about us

Where did you hear about us (other)

Instrument Information

Drop-off Location

Instrument Category

Instrument Type

Other Instrument Details

Instrument Make

Instrument Model

Instrument Serial Number

Instrument Description

Are there any stories you’d like to share with us about this instrument? This may be used on social media and/or in press releases and other marketing materials.

Please upload a picture of the instrument

Donation (optional)

Would you help cover the cost of instrument repairs? No gift is too small! $50 is the average cost to repair an instrument before it is placed with a school, community organization, or student. If you think your donated instrument needs more extensive repairs, consider increasing your financial gift. You can use the form below or text “REPAIR” to 443-21 or donate online at www.musicopia.net/donate.

Would you like to make a donation today?

Payment Information

Dollar Amount

Name on Card

Card Number

Code

Billing Email

Please Note: There may be a delay between when you drop off your instrument and when we send an
acknowledgement letter. Donor is responsible for estimating the value of the instrument. If verification is
needed for tax purposes, please consult a qualified musical instrument appraiser before making donation.

By submitting this form, you are automatically added to our e-newsletter mailing list. You can unsubscribe at any time.

For more information, call 215.829.9522 x 106, email
gom@musicopia.org or visit www.musicopia.org

Please be patient. This form can take a few seconds to process.

Upon submission, please print confirmation page with the barcode and attach it to the instrument when you drop it off.

Contact Information