Donate an Auction Item

Fields marked * require an entry.

Please complete the form below to donate an item or service to our online auction.

The online auction will run June 14-20.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Please tell us more (include restrictions, what type of item or service this is, and if it is a physical item.) Also, please indicate if anyone directly solicited this donation from you.:

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:

Work Phone:

Email:*