Item Donation Form
Please complete all fields.
* Required
Email address
*
Your email
Name of Donor
*
Your answer
Donor Address
Your answer
Donor City
Your answer
Donor State
Your answer
Donor Zip
Your answer
Item Title
*
Your answer
Please give a longer, detailed description of the item.
*
Your answer
What is the Fair Market Value of the item?
*
Your answer
Have you turned in the item?
*
Yes
No
Other:
Where is the item currently located? Or, when do you expect to turn in the item?
*
Your answer
Please list a Rotarian to contact with questions about this item.
*
Your answer
Email Address (for receipt purposes)
*
Your answer
Send me a copy of my responses.
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