Item Donations

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MVM VII

Saturday, October 10, 2015

Item Information

Item Name:*

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Estimated Value $:*

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Please enter a valid decimal number as nnn.nn

Item Description:*

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Notes:

I am a(n):*

Individual Donor

Business Donor

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I would like to remain anonymous:*

Yes

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Item to be:*

Mailed

Delivered

Picked-up

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Certificates

Please prepare an auction certificate for me.:

Yes

Certificate expires on year from date of auction unless date otherwise noted here:

Please enter a date as mm/dd/yyyy

This item may be auctioned:

Once

Twice

Three times

Contact Information

Company:*

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First Name:*

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Middle Name:

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Last Name:*

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Address:*

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Address2:

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City:*

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State:*

Province State is required for the United States

Postal Code:*

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Country / Location:*

Country is Required

At least one phone number is required.* Please enter at least one phone number

Mobile Phone:

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Home Phone:

Please enter a value for Home Phone: Please enter a valid phone number. Use x to denote extension

Work Phone:

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Email:*

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