Fields marked * require an entry.

Auction Procurement Form

Please fill out the following fields as completely as possible.

When entering the Item Description for a certificate item that will be printed by LLSEF, please enter what will go on the certificate.

Item Donations

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

Is this a physical item or a certificate item?*

If physical item, who will deliver to auction site on October 20? Please add contact info, if not donor.:

If certificate item, will donor provide or will LLSEF print it?*

Procured by:

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:

Work Phone:

Email:*