Auction Item Donation 2014

Fields marked * require an entry.

Please complete the following information if you wish to donate items to our auction. We appreciate your generosity!

Items received by March 1, 2014 will be used for the Winter Challenge. Items received after that date will be gratefully accepted and used to support our other terrific events.

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

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:*