Procurement Form

Fields marked * require an entry.

Procurement Form

Thank you for donating an item or package to the JDS Auction. Fill out the form below completely. We will be in touch with you if we need additional information.

Please Note: We reserve the right to combine your item with another package.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Restrictions or Expiration Date?*

Please check one of these boxes:

Donor to mail gift certificate or item to JDS

JDS has permission to create a gift certificate for this item

Donor would like JDS to pick up gift certificate or item

Donor Name (if different than person filling out this form):

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Email:*

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