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Item Donation

Item Information

Item Name:*

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Estimated Value $:*

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Item Description:*

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Notes:

I am a(n):*

Individual Donor

Business Donor

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I would like to remain anonymous:*

Yes

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DONATION DETAILS

Name of Donor (as you would like it to appear):*

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DELIVERY

Item Delivery:*

I will deliver

Please contact me to arrange pick-up

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Certificate:

I will provide a gift certificate

Please create a gift certificate for me

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Include donor info below:*

Yes

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Contact Information

Company:*

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First Name:*

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Middle Name:

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Last Name:*

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Address:*

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Address2:

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City:*

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State:*

Province State is required for the United States

Postal Code:*

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Country / Location:*

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At least one phone number is required.* Please enter at least one phone number

Mobile Phone:

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Home Phone:

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Work Phone:

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Email:*

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