Auction Item Donation

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Fields marked * require an entry.

Online Procurement Form

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Restrictions/Expiration (if any):

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Expiration Date (if Any):*

Yes

No

Would you like FareStart to create a certificate for you to be given to the winner?*

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:*

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