2017 Encompass Autumn Gala Procurement Form
Email address
Contact Information
Donor/Business Name
For catalog and promotional materials
Your answer
Name of Contact Person
If different than donor
Your answer
Mailing Address
Your answer
City
Your answer
State
Your answer
ZIP
Your answer
Phone
Your answer
Donation Details
Donated Item
One item per form, please
Your answer
Description of Item
Indicate limitations or restrictions
Your answer
Value of Donated Item
Your answer
Donated Item Type
Additional Information
Date of Delivery
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DD
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YYYY
Solicitor's Name and Phone Number
Who contacted you about this donation?
Your answer
Signature of Donor
Please type your full name as an electronic signature
Your answer
Today's Date
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DD
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YYYY
Questions or concerns?
Please contact Chelsea Nelson, Development Associate, at chelsea.nelson@encompassnw.org or 425.888.2777.
A copy of your responses will be emailed to the address you provided.
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