Your Information

Donor Name :
(As it should appear in silent auction materials)
Contact Person :
e-mail :
Phone :
Address :
 
City :
State :
ZIP :

Item Details

A) Detailed Description of Item(s) Donated:
   

B) Market (Retail) Value of Donation:
  $

C) Minimum Bid that you wish to be placed on the item (optional):
  $

D) Delivery Options:
Please select one of the following concerning delivery of the donation to HRC.

Please come to my location of business to pick up the donation. Pick up date:

I will mail the items on or about
if possible, please mail donations no later than April 15.

Please prepare a gift certificate to be provided to the winning bidder that may exchange for the donated item(s) after the Silent Auction.