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Apartment, suite, etc. (optional)
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Questionnaire

Business Name if applicable. If this is a personal raffle/auction item/s, put N/A.

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Business Location/s applicable for your donated item if different from above. If not, please put, See Above or N/A.

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Description of item/s:

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Any restrictions on usage (Ex. If its a restaurant gift card, are there any excluded items or Dine-In Only..etc)

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Pick-Up or Mailing Item/s:

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Point of Contact Name and Phone Number if different from above. If not, please put, See Above.

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Item/s Value:

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Picture of Item/s being provided:

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