Item Donation

Fields marked * require an entry.

Thank you for donating your items to the Sexless Soiree annual auction.

Please indicate in the NOTES section any restrictions (i.e. expiration date) and if you will be 1) bringing/sending the item to the clinic, or 2) if it needs to be picked up, or 3) if we should make a gift certificate for your item.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes, Restrictions, and Drop off Options:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

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:*

Thank you to our 2014 Sponsors