Quality Medical Relief International - Donate to Quality Medical Relief International

September 3, 2008

DONATE to Quality Medical Relief International

E-mail Address: *
Contact Name? *
Contact Address/Phone number?
If donating money, when should we contact you?
If donating medicine/supplies, when should we contact you?
Type of equipment/medicine/supplies?
Year(s) of manufacture, if known?
If equipment, last time used?
If equipment, any known problems?
Operations/Technical manual/ (Y/N)
Is manual available?
Are parts still available if known (where)?
Specifications? (Volts,Amps,etc.)
Location of equipment (street address)?
Year of last service and calibration?
Who performed the service?
Any other pertinent information we need to know?


* Required

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