Item Donation

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Fields marked * require an entry.

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

Will you be providing a certificate or would you like us to create one?*

Yes, I will provide a certificate by 6/30/22

No, please create a certificate on my behalf

Please list any restrictions to the redemption of this item:*

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*

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