DONATE AN ITEM

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Comments or questions?

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Date for pick up:

When will your donation be ready for pick up?*

Pick up location:

Is the pick up location the same as the billing address?*

Yes

No

If no, where should we pick it up?

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:*