1.  Name:

2.  Organization:

3.  Address:

4.  City:   State/Province:    Zip/Postal Code:

5.  Business Phone:    Home Phone:

6.  E-Mail:

7.  Donor wishes bid proceeds from this donation to be applied to:
    
     (please indicate a specific program or fund, or leave blank if you wish the Foundation to apply proceeds
      where they are most needed.)

8.  Name of Item:

9.  Suggested Retail Value:

10. Photos/descriptions available at (web site URL):
   

11. Description:
   

12. Qualifying criteria, if any, for winning bidder: (please indicate any special restrictions, for example,
     clothing sizes, weight and/or height restrictions for rides, location where item must be delivered/collected, etc.)
   

13. Winning bidder collects product or service purchased by:(please provide all necessary contact information
     for arranging delivery after the auction, or indicate if item is to be picked up at the auction)