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Product Donation Request Form

Donating our products to support underserved patient care and humanitarian needs

We are proud to play a leadership role in advancing health equity, and believe all patients should have access to our products when medically necessary.

Our focus

We focus our Product Donations on voluntary medical care delivered to underserved patient populations and for humanitarian need where no reimbursement from government or commercial entities is requested by the organization or treating healthcare provider.

Important Note: B. Braun will not ship donated product across country borders and may not be named as the exporter of record for shipments to international destinations.   

If your program falls within our areas of focus as described above, we invite you to request a Product Donation from B. Braun. For any questions, or if you encounter any problems, please send us an email at GrantRequests@bbraunusa.com.

Product Donation Request Form

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  • Albania
  • Algeria
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  • Andorra
  • Angola
  • Anguilla
  • Antarctica
  • Antigua And Barbuda
  • Argentina
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  • Ecuador
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  • Equatorial Guinea
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  • Estonia
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  • Falkland Islands
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  • Fiji
  • Finland
  • France
  • French Guiana
  • French Polynesia
  • French Southern Territories
  • Gabon
  • Gambia
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  • Ghana
  • Gibraltar
  • Greece
  • Greenland
  • Grenada
  • Guadeloupe
  • Guam
  • Guatemala
  • Guinea
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  • Guyana
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  • New Caledonia
  • New Zealand
  • Nicaragua
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  • Nigeria
  • Niue
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  • Northern Mariana Islands
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Palestinian territories
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Pitcairn
  • Poland
  • Portugal
  • Puerto Rico
  • Qatar
  • Réunion
  • Romania
  • Russian Federation
  • Rwanda
  • Saint Helena
  • Saint Kitts And Nevis
  • Saint Lucia
  • Saint Vincent And The Grenadines
  • Saint-Pierre and Miquelon
  • Samoa
  • San Marino
  • São Tomé and Príncipe
  • Saudi Arabia
  • Senegal
  • Serbia and Montenegro
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Georgia And The South Sandwich Islands
  • South Africa
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Svalbard And Jan Mayen
  • Swaziland
  • Sweden
  • Switzerland
  • Syrian Arab Republic
  • Taiwan (Republic of China)
  • Tajikistan
  • Tanzania - United Republic Of
  • Thailand
  • Timor-Leste
  • Togo
  • Tokelau
  • Tonga
  • Trinidad And Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Turks And Caicos Islands
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom
  • United States Minor Outlying Islands
  • Uruguay
  • USA
  • Uzbekistan
  • Vanuatu
  • Vatican City State
  • Venezuela
  • Viet Nam
  • Virgin Islands - U.S.
  • Virgin Islands - British
  • Wallis And Futuna
  • Western Sahara
  • Yemen
  • Zambia
  • Zimbabwe (Zimbabwe)
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  • Afghanistan
  • Åland Islands
  • Albania
  • Algeria
  • American Samoa
  • Andorra
  • Angola
  • Anguilla
  • Antarctica
  • Antigua And Barbuda
  • Argentina
  • Armenia
  • Aruba
  • Australia
  • Austria
  • Azerbaijan
  • Bahamas
  • Bahrain
  • Bangladesh
  • Barbados
  • Belarus
  • Belgium
  • Belize
  • Benin
  • Bermuda
  • Bhutan
  • Bolivia
  • Bosnia And Herzegovina
  • Botswana
  • Bouvet Island
  • Brazil
  • British Indian Ocean Territory
  • Brunei Darussalam
  • Bulgaria
  • Burkina Faso
  • Burundi
  • Cambodia
  • Cameroon
  • Canada
  • Cape Verde
  • Cayman Islands
  • Central African Republic
  • Chad
  • Chile
  • China - mainland
  • Christmas Island
  • Cocos (Keeling) Islands
  • Colombia
  • Comoros
  • Congo - Republic of the
  • Congo - Democratic Republic Of
  • Cook Islands
  • Costa Rica
  • Côte d'Ivoire
  • Croatia
  • Cuba
  • Curacao
  • Cyprus
  • Czech Republic
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Ethiopia
  • Falkland Islands
  • Faroe Islands
  • Fiji
  • Finland
  • France
  • French Guiana
  • French Polynesia
  • French Southern Territories
  • Gabon
  • Gambia
  • Georgia
  • Germany
  • Ghana
  • Gibraltar
  • Greece
  • Greenland
  • Grenada
  • Guadeloupe
  • Guam
  • Guatemala
  • Guinea
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Heard Island And McDonald Islands
  • Honduras
  • Hong Kong
  • Hungary
  • Iceland
  • India
  • Indonesia
  • Iran - Islamic Republic of
  • Iraq
  • Ireland
  • Israel
  • Italy
  • Jamaica
  • Japan
  • Jordan
  • Kazakhstan
  • Kenya
  • Kiribati
  • Korea - Democratic People's Republic Of
  • Korea - Republic Of
  • Kuwait
  • Kyrgyzstan
  • Lao People's Democratic Republic
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libyan Arab Jamahiriya
  • Liechtenstein
  • Lithuania
  • Luxembourg
  • Macao
  • Macedonia - Former Yugoslav Republic of
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Martinique
  • Mauritania
  • Mauritius
  • Mayotte
  • Mexico
  • Micronesia, Federated States Of
  • Moldova - Republic Of
  • Monaco
  • Mongolia
  • Montserrat
  • Morocco
  • Mozambique
  • Myanmar
  • Namibia
  • Nauru
  • Nepal
  • Netherlands
  • Netherlands Antilles
  • New Caledonia
  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • Niue
  • Norfolk Island
  • Northern Mariana Islands
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Palestinian territories
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Pitcairn
  • Poland
  • Portugal
  • Puerto Rico
  • Qatar
  • Réunion
  • Romania
  • Russian Federation
  • Rwanda
  • Saint Helena
  • Saint Kitts And Nevis
  • Saint Lucia
  • Saint Vincent And The Grenadines
  • Saint-Pierre and Miquelon
  • Samoa
  • San Marino
  • São Tomé and Príncipe
  • Saudi Arabia
  • Senegal
  • Serbia and Montenegro
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Georgia And The South Sandwich Islands
  • South Africa
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Svalbard And Jan Mayen
  • Swaziland
  • Sweden
  • Switzerland
  • Syrian Arab Republic
  • Taiwan (Republic of China)
  • Tajikistan
  • Tanzania - United Republic Of
  • Thailand
  • Timor-Leste
  • Togo
  • Tokelau
  • Tonga
  • Trinidad And Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Turks And Caicos Islands
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom
  • United States Minor Outlying Islands
  • Uruguay
  • USA
  • Uzbekistan
  • Vanuatu
  • Vatican City State
  • Venezuela
  • Viet Nam
  • Virgin Islands - U.S.
  • Virgin Islands - British
  • Wallis And Futuna
  • Western Sahara
  • Yemen
  • Zambia
  • Zimbabwe (Zimbabwe)
  • Afghanistan
  • Åland Islands
  • Albania
  • Algeria
  • American Samoa
  • Andorra
  • Angola
  • Anguilla
  • Antarctica
  • Antigua And Barbuda
  • Argentina
  • Armenia
  • Aruba
  • Australia
  • Austria
  • Azerbaijan
  • Bahamas
  • Bahrain
  • Bangladesh
  • Barbados
  • Belarus
  • Belgium
  • Belize
  • Benin
  • Bermuda
  • Bhutan
  • Bolivia
  • Bosnia And Herzegovina
  • Botswana
  • Bouvet Island
  • Brazil
  • British Indian Ocean Territory
  • Brunei Darussalam
  • Bulgaria
  • Burkina Faso
  • Burundi
  • Cambodia
  • Cameroon
  • Canada
  • Cape Verde
  • Cayman Islands
  • Central African Republic
  • Chad
  • Chile
  • China - mainland
  • Christmas Island
  • Cocos (Keeling) Islands
  • Colombia
  • Comoros
  • Congo - Republic of the
  • Congo - Democratic Republic Of
  • Cook Islands
  • Costa Rica
  • Côte d'Ivoire
  • Croatia
  • Cuba
  • Curacao
  • Cyprus
  • Czech Republic
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Ethiopia
  • Falkland Islands
  • Faroe Islands
  • Fiji
  • Finland
  • France
  • French Guiana
  • French Polynesia
  • French Southern Territories
  • Gabon
  • Gambia
  • Georgia
  • Germany
  • Ghana
  • Gibraltar
  • Greece
  • Greenland
  • Grenada
  • Guadeloupe
  • Guam
  • Guatemala
  • Guinea
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Heard Island And McDonald Islands
  • Honduras
  • Hong Kong
  • Hungary
  • Iceland
  • India
  • Indonesia
  • Iran - Islamic Republic of
  • Iraq
  • Ireland
  • Israel
  • Italy
  • Jamaica
  • Japan
  • Jordan
  • Kazakhstan
  • Kenya
  • Kiribati
  • Korea - Democratic People's Republic Of
  • Korea - Republic Of
  • Kuwait
  • Kyrgyzstan
  • Lao People's Democratic Republic
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libyan Arab Jamahiriya
  • Liechtenstein
  • Lithuania
  • Luxembourg
  • Macao
  • Macedonia - Former Yugoslav Republic of
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Martinique
  • Mauritania
  • Mauritius
  • Mayotte
  • Mexico
  • Micronesia, Federated States Of
  • Moldova - Republic Of
  • Monaco
  • Mongolia
  • Montserrat
  • Morocco
  • Mozambique
  • Myanmar
  • Namibia
  • Nauru
  • Nepal
  • Netherlands
  • Netherlands Antilles
  • New Caledonia
  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • Niue
  • Norfolk Island
  • Northern Mariana Islands
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Palestinian territories
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Pitcairn
  • Poland
  • Portugal
  • Puerto Rico
  • Qatar
  • Réunion
  • Romania
  • Russian Federation
  • Rwanda
  • Saint Helena
  • Saint Kitts And Nevis
  • Saint Lucia
  • Saint Vincent And The Grenadines
  • Saint-Pierre and Miquelon
  • Samoa
  • San Marino
  • São Tomé and Príncipe
  • Saudi Arabia
  • Senegal
  • Serbia and Montenegro
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Georgia And The South Sandwich Islands
  • South Africa
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Svalbard And Jan Mayen
  • Swaziland
  • Sweden
  • Switzerland
  • Syrian Arab Republic
  • Taiwan (Republic of China)
  • Tajikistan
  • Tanzania - United Republic Of
  • Thailand
  • Timor-Leste
  • Togo
  • Tokelau
  • Tonga
  • Trinidad And Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Turks And Caicos Islands
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom
  • United States Minor Outlying Islands
  • Uruguay
  • USA
  • Uzbekistan
  • Vanuatu
  • Vatican City State
  • Venezuela
  • Viet Nam
  • Virgin Islands - U.S.
  • Virgin Islands - British
  • Wallis And Futuna
  • Western Sahara
  • Yemen
  • Zambia
  • Zimbabwe (Zimbabwe)

Product shipping information (may not be to a personal address) if different from organization information provided above:

The following supporting documentation must be attached and submitted with the Product Donation Form:

     

1. Non-profit designation letter *

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2. IRS form W9 *

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3. Statement of charitable mission *

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4. If requesting products a complete list of the products requested using product name (or SKU) and quantity of each. This information can be found on B. Braun’s website. *

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By submitting this request, I acknowledge the B. Braun will require a signed agreement in the event my request is approved and before providing the approved support. 

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