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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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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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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