Please select what kind of donation you’d like to request (Check All That Apply)
MonetaryProduct

Name of Organization

Tax ID (EIN) Find it here

Organization Location
—Please choose an option—AlabamaOklahomaSouth Carolina

Address of Organization

City

State
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Postal Code

Contact Name

Contact E-mail

Please attach any sponsorship packets, or organization information here

How will this donation benefit your organization or the community?

Please describe how this donation aligns with Milo’s focus areas and how it will create an impact

I agree to be bound by the agreement below

DONATION, WAIVER OF LIABILITY, AND INDEMNIFICATION FOR RECEIPT OF DONATED GOODS

RECIPIENT acknowledges receipt from Milo’s Tea Company, Inc. (“Milo’s”) of the items detailed above, (“Donated
Goods”) as of the date noted below. Milo’s is providing the Donated Goods to RECIPIENT in such capacity and at no
charge. RECIPIENT voluntarily accepts the Donated Goods “As-Is.”

In accepting the item "as is" I understand that it comes without a warranty. I will not hold Milo's responsible for any defects. I also understand that Milo's will not be held liable, under any circumstances, for any damages resulting from the use or inability to use the Product.

In consideration for accepting the Donated Goods, RECIPIENT agrees to the following:

1. RECEIPT OF DONATED GOODS. The RECIPIENT acknowledges receipt of Donated Goods donated by Milo’s to the
   RECIPIENT. RECIPIENT attests that no goods or services were provided by RECIPIENT to Milo’s in exchange for the
   Donated Goods.

2. USAGE. The RECIPIENT agrees and understands that the Donated Goods may not be transferred, sold, given or
   assigned to any other person/entity and that the Donated Goods must be received, stored, and distributed by the
   RECIPIENT at a business location—not a personal residence. RECIPIENT attests that the use of the product donated to
   us by Milo’s Tea Company, Inc. is related to the purpose or function constituting our exemption under IRC §501 and the
   product is to be used solely for the care of the ill, needy, or infants.

3. NO WARRANTIES. Milo’s, and its donors, its subsidiaries, affiliates, and each of its respective officers, directors,
   employees, agents, counsels, successors, and assigns (“Milo’s Parties”), make no representations whatsoever, extend
   no warranties of any kind, either express or implied, including but not limited to the implied warranties of
   merchantability or fitness for a particular purpose, and assumes no responsibilities whatsoever with respect to design,
   development, manufacture, or use of the Donated Goods. Furthermore, in no event shall Milo’s Parties be liable for
   direct, indirect, special, consequential, incidental or punitive loss, damage or expenses arising out of or in connection
   with this agreement, including but not limited to recipient's use of the Donated Goods or receipt of the Donated Goods
   from Milo’s.

4. WAIVEROFLIABILITY. RECIPIENT does hereby waive, release and discharge any and all claims for damages for
   personal injury, death, property damage, any claim in tort, or any other claim, regardless of legal theory, that may
   hereafter accrue as a result of the use of the Donated Goods. The entire risk as to the performance of the Donated
   Goods is assumed by RECIPIENT. In no event shall the Milo’s Parties be responsible or liable for any direct, indirect,
   special, incidental, consequential damages, lost profits, or any other economic or physical loss or damage to any
   individual regardless of legal theory resulting from use of the Donated Goods. The above limitations on liability apply
   even though Milo’s may have been advised of the possibility of such damage.

5. INDEMNIFICATION. RECIPIENT agrees to indemnify and hold harmless Milo’s Parties from any and all claims, liability
   and damages, arising from the use of the Donated Goods except those arising from the sole gross negligence or willful
   misconduct of Milo’s.

THE UNDERSIGNED, WHO IS AUTHORIZED TO REPRESENT THE RECIPIENT HAS CAREFULLY READ THIS DONATION,
WAIVER OF LIABILITY AND INDEMNIFICATION AGREEMENT AND UNDERSTANDS ITS CONTENTS. RECIPIENT IS
AWARE THAT THIS IS A COMPLETE RELEASE OF LIABILITY BY RECIPIENT.