Donation Certificate

For a successful submission of the form, data is required in all fields except as noted.

Donor/Merchant Information

First Name:
Last Name:
Business: (if applicable)
Street Address:
City, State, Zip:
Phone Number:
E-mail: (optional)
Web Site: (optional)

MSC Contact /Solicitor Information

First Name:
Last Name:
Street Address:
City, State, Zip:
Phone Number:
E-mail: (optional)

Item Information

Repeat Donation? (Have you donated this item to previous MSC auctions?)	Yes   No   Not Sure
Item Category: (select from list)	Accommodations & Travel Arts & Crafts Autographed Items Clothing, Collectibles & Merchandise Edibles Fitness, Health & Beauty Kids' Merchandise Restaurants Services Shows & Performances Special Events & Workshops (flat bidding) Sports & Recreation Miscellaneous
Item Name:
Description: (Please be as descriptive as possible. This text will form the basis of the description published in the auction catalog.)
Where do you want the donation to be sold: ?	Boutique   Gala Store   Silent Auction   No Preference
Est. Value: $
(Please round off to nearest whole dollar and only put the number without the $ sign, such as 40 for forty dollars.)
Notes/special instructions to winner etc. (optional)