| DONOR INFORMATION | |||
|---|---|---|---|
| Individual Donor's Name or Company | Person to be Thanked (Name and Title) | ||
| Print Name as it Should Appear in Event Program (if applicable) | Signature or Donor | ||
| Address | City/State | Zip Code | Phone |
| DONATION INFORMATION AND RECEIPT | |||
| Date of Donation | Received by | Value of Professional Services $ Rate per Hour $ | |
| Estimated $ Value | Estimate Provided by (Name and Title) | Received by | |
| Description of donation (Including limitations, valid dates, and conditions): | |||
|
If goods or materials, will you deliver? YES __________ NO __________ If YES - When? ________________________________________________________ If NO - Where and When can it be picked up? ________________________________________________________ Gift Certificate: Attached __________ To Be Mailed __________ Valid From __________ Until __________ |
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