We, Joel Hodge, Director of Operations in representation of the Wheelchair Foundation, from here forward to be called the “Foundation,” and _________________ in representation of _____________________________________, from here forward to be called the “Consignee,” agree to complete the following obligations:

First: The Foundation will purchase for donation to the Consignee a total of _____ wheelchairs with the following general characteristics:

_____ wheelchairs with 20 inch wide seats,

_____ wheelchairs with 18 inch wide seats,

_____ wheelchairs with 16 inch wide seats,

_____ wheelchairs with 14 inch wide seats, and

_____ wheelchairs with 12 inch wide seats.

All of the wheelchairs are made of high resistance materials; foldable for easy transportation; with adjustable footrests, and with movable armrests to facilitate access.

Second: The Foundation will pay transportation costs to ship the chairs to the physical address specified by the Consignee in ______________.

Specified address:

______________________________________

______________________________________

______________________________________

______________________________________

______________________________________

Third: The Consignee will be responsible for clearing the chairs from customs and will pay all customs, brokerage and storage fees. The consignee will process all paperwork necessary to import the wheelchairs as a tax-free charitable donation. The Foundation will provide the Consignee with all necessary original customs documents prior to the wheelchairs arrival, including but not limited to: a letter of donation directed which states that the shipment is a donation without any intent for commercial gain, and a non-commercial invoice. The bill of lading will be provided by the shipping agency. The mutual goal will be to clear the wheelchairs through customs as rapidly as possible.

Fourth: The Consignee is responsible for distributing the wheelchairs to their end recipients; for which they must:

1. Identify the individuals to be provided a wheelchair.
2. Organize a donation ceremony, including the participation of the organization indicated in the Fifth clause of this agreement, and any representatives of the Foundation or other special guests who might be present. The donation ceremony should involve a press conference and a wheelchair distribution involving not less than 25 disabled recipients.
3. Provide to the Foundation photographs of each of the wheelchair recipients. These photographs must comply with the specifications established in the annex of this agreement, named “Photograph and Identification Card Requirements.” The Foundation will provide the Consignee with disposable cameras and identification cards. The Consignee will ensure a photograph is taken of each recipient seated in their new wheelchair holding the identification card, upon which will be written the recipient’s age and name. Following the distribution of the wheelchairs, the Consignee will return the cameras and the filled-in identification cards to the Foundation. Failure to comply with this clause will reduce the likelihood of the Consignee receiving future donations and will remove the Foundation’s ability to demonstrate to its donors the good use of their contributions.

Important Notice : It is critical that the Consignee and distributing organization(s) are aware that the standard manual wheelchairs provided by Wheelchair Foundation are not intended for use by individuals affected by some neuromuscular diseases, such as Cerebral Palsy, severe cases of Polio, Multiple Sclerosis, or other conditions that effect skeletal structure (extreme deformation of limbs or torso, etc.) or body motor control (spastic movement, seizures, convulsions, tremors, etc.). Individuals with such conditions may require specific specialized wheelchairs, and additional appliances not provided by Wheelchair Foundation to assure proper seating and support. Placing such individuals in standard manual wheelchairs can result in severe harm to the individual recipient and should be avoided. If the consignee or distributing organization is unable to assess whether a standard manual wheelchair is appropriate for any particular individual recipient it is recommended by Wheelchair Foundation that the consignee or distributing organization consult with a physician or specialist to determine whether or not a standard manual wheelchair will be appropriate for the intended individual recipient.

Fifth: The wheelchairs provided under the terms of this donation agreement have been sponsored by the Wheelchair Foundation and _______________________________. The contact for this organization is: ____________________________________________ in order to comply with the stipulations outlined in clause 4b above.

Sixth: The Consignee may conduct all communications for the completion of this agreement with Joel Hodge, Director of Operations, through any of the following means of communication:

Tel: 925-648-3841 Mobile : 925-381-8447 Fax: 925-648-0163

E-mail: jhodge@wheelchairfoundation.org.

Seventh: The Consignee will remit via fax a copy of this agreement signed by its representative.

In good faith, the Consignee accepts the terms and conditions set out above.

ANNEX: Photograph and Identification Card Requirements

The Wheelchair Foundation's Photo Identification Cards are used to identify the recipients of wheelchairs provided by our organization. These cards are to be used when photographing wheelchair recipients. Each card has a six-digit identification number, followed by a three-letter alphanumeric country code and a space for the recipients' name and age. You should receive one card for every wheelchair provided.

How to use these cards:

-Please PRINT the recipients NAME and AGE on the front of the card in the space provided. Please print clearly ( using the standard modern Roman or Latin alphabet) .

-Please have the individual receiving the wheelchair hold the card in plain view for photographing. Please assist individuals who are unable to hold the cards themselves.

-Photograph the recipient while he or she is seated in the donated wheelchair holding the Photo Identification Card.

-Please photograph recipients vertically or “portrait” style (rotate your camera 90 degrees from the normal position). Make sure that the recipient, the wheelchair and the photo identification card are all clearly visible when photographing.

-Please use a flash if necessary.

-Please provide contact information for the person responsible for photos of recipients (name, telephone numbers, e-mail, physical address, etc.).

- Please return all undeveloped film, photos and photo identification cards to Wheelchair Foundation . We will develop undeveloped film. Cameras and Placards can be returned to Wheelchair Foundation at no cost to the consignee by using DHL import number 965268084 when shipping.

Failure to return photos of recipients and photo identification cards violates our agreement with your organization and will definitely effect future cooperation! Please make every effort to provide good photos of recipients and identification information. In most instances it is not possible to obtain photos of wheelchair recipients other than at the time of presentation! Take two photos if necessary. The information you provide us with directly affects our fundraising efforts, our ability to heighten awareness, and our ability to provide wheelchairs to individuals in need.

If you have questions please contact Joel Hodge at Wheelchair Foundation (925) 736-8234, fax (925) 648-0163, or e-mail jhodge@wheelchairfoundation.org . Thank you for your cooperation!