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DONATE AN AUCTION ITEM

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

Restrictions and Expiration date:*

Please check one of these boxes:*

Donor to mail or deliver gift certificate or item to EC

EC has permission to create a gift certificate for this item

Donor would like EC to pick up gift certificate or item

Donor Name (if different than the person filling out this form):

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*