Procurement Form

Fields marked * require an entry.

Please use this form to donate item(s) for Denise Louie Education Center's 2010 Dinner and Auction.

We are always looking for items in our LIVE and SILENT auctions.

Your donation is fully tax-deductible as we are a 501(c)3 organization. Our tax identification number is 91-1016974.

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

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:*

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