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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

Is your donation an Item, Gift Card/Certificate or and Item AND Gift Card/Certificate:*

If you donation is a Gift Certificate, do you need the PAC to create it for you based on the description you entered above?

Yes

No

Please note here any additional information you would like the bidders to know about your donation such as black out dates, expiration, model numbers, website, etc.:

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:*

Donate An Auction Item

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