Product Donation Form

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B. Braun considers product donation requests to support humanitarian medical treatment under the direction of charitable non-profit organizations. Product donations are subject to available inventory at the time of shipment.

Recipient organizations and B. Braun acknowledge and agree that any donation shall not obligate the organization to purchase, use or recommend the use of any B. Braun products. All product donation requests need to be received by B. Braun at least three (3) months before the donation is required. Please complete this form and submit it for processing; requests with missing information or supporting documentation will not be considered.

Recipient Organization Name

Recipient Organization Address Line 1

Recipient Organization Address Line 2

Recipient Organization City

Recipient Organization State

Recipient Organization Zip

Recipient Organization Country

Recipient Organization Tax ID Number

Recipient Organization Tax Status

Recipient Organization Type

Recipient Organization Contact Name

Recipient Organization Contact Job Title

Recipient Organization Contact Email

Recipient Organization Contact Phone

Event or Mission Name

Event or Mission Start Date

Event or Mission State or Country

Event or Mission Description

Donating Company

Expected Delivery Date of Product(s)

Describe the Reason for Requesting Product Donation

Shipping Information, if different from info provided above:

Shipping Organization Name

Shipping Organization Address

Shipping Contact Name

Shipping Contact Email

Shipping Contact Phone

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

1. Non-Profit Designation Letter

2. IRS Form W9

3. Statement of Charitable Mission

4. List of requested products using B. Braun’s Product Name and Number, and Quantity. This information can be found on B. Braun’s website.

Requests and Documentation may also be

Emailed to:
GrantRequests@bbraunusa.com

Mailed to:
c/o B. Braun Medical Inc.
Attention: Corporate Compliance
824 Twelfth Avenue
Bethlehem PA, 18018

Compliance is what gives us the right to do business. At B. Braun, each of our employees is responsible for doing the right thing for the Company and for themselves. Acting in compliance allows us to continue to make a true difference for our customers and the patients they serve.

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Requests and Documentation may also be

Compliance is what gives us the right to do business. At B. Braun, each of our employees is responsible for doing the right thing for the Company and for themselves. Acting in compliance allows us to continue to make a true difference for our customers and the patients they serve.