2019 ACTion for Jackson Auction Donor Form
For questions about this form or the auction, please contact jamie@ebresearch.org or call (212)844-9369. Please complete this form by October 15th.

All donations are tax deductible to the fullest extent of the law. EB Research Partnership's Federal Tax Identification Number is 27-2417202.

Email address *
Company/Donor Name *
Your answer
Contact Name *
Your answer
Street *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Solicitor's Name & Phone or Email Address
Your answer
Auction Item *
Your answer
Estimated Value of Auction Item *
Your answer
Description of Item *
as it should appear in all event materials
Your answer
Presentation of Item
Example: gift certificate, physical item, poster display, etc.
Your answer
Do you need us to make a gift certificate for you? *
Example: gift certificate, physical item, poster display, etc.
Please list ALL restrictions, blackout dates, expiration dates or limitations: *
If this does not apply to the donated item, please write "None"
Your answer
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