2021 Falaya Fling Item Donation Form
SSA TAX ID #72-0605149
Donor's Name (Please list as name should appear for recognition) *
Contact Name *
Contact Street/PO Box Address *
Contact City Address *
Contact State Address *
Contact Zip Code
Contact Email *
Relationship to SSA *
Item Name *
Item Description *
Item Value *
Item Requires Pick up *
List pick up address if different than above.
If Item is a Gift Certificate, list expiration date
If Item is a Gift Certificate, is certificate
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