Auction & In Kind Donations

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Additional Information

Restrictions (if any):

Expiration Date:

Date Restriction:

Maximum People:

Date Item(s) will be delivered:

Intangible Items:

Gift Certificate given with this form

Gift Certificate will be given at a later date

Auction Committee will create gift certificate

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*