Materials Supply Contribution

Let's grab some details to get your action on the record
This form should be super simple and take no more than five minutes.

Remember, you own the data that you record on the East Coast Exchange and any data that will be publicly displayed will have a 'Public' label below the field.
These materials were supplied by

IndividualOrganisation / Group
Organisation / Group name
Public
Contact person*

Public
Email*
Phone number*
Are you completing this form on behalf of the individual or organisation?

YesNo
Record your name

First NameLast Name
Your phone number
Yes, I have their consent to record this information

YesNo - please get their consent before continuing

Tell us about the materials you have supplied
Date supplied

MonthDayYear
Public
Location these materials were supplied from
Enter address of store or business. This will be publicly visible on a map so if you would prefer for this not to be displayed you can leave this blank.
Location these materials were supplied from
Location these materials were supplied from
Note this will be publicly visible on a map so if you would prefer for the specific address not to be visible enter just the street or suburb.
Materials supplied

JarsContainersBoxesGumbootsGlovesMasksShovelFencing materialsOther
Public
Number of items provided
Public
Location these materials were delivered to
Enter the address
Location these materials were delivered

How would you like this to show up on the record?
I would like to

Donate these materials. Any Action Points I earn I would like to be donated back to the community effort.Earn Action Points that could be eligible for Programme funding.
Estimated retail value of these materials
Public
What is fair compensation for these materials?
Action Points
Public

Let's capture some quick info so we can verify this
Your points are only earned or donated if your actions can be verified so please supply high-quality evidence below.
Name and organisation of person who received these materials
Contact details of person who received these materials
Phone and / or email
Upload images of the materials at the delivery location

Make sure the volume of materials supplied is visible. Please ensure location services on your phone is turned on so the location can be verified.
Cancelof
Upload any other relevant info e.g. invoices

Cancelof
Add any other notes

I have read and agreed to the Exchange rules.I understand there is no guarantee that I will receive any Programme funds at any time or that my donated points will be funded.
View the East Coast Exchange rules here.
Should be Empty:

Let's grab some details to get your action on the record