Item Donation

Fields marked * require an entry.

Rotary Christmas Auction Donation Form

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Use Restrictions if any, Is item a Certificate?, do you want a receipt for you donation?

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:

Email:*