Please complete and print this form and include it with each package/item you donate for the DRAW Auction.

Your name: ________________________________________________

Company (if applicable): ________________________________________________

Address: _______________________________________________________________

City: ________________________________________________________________

State: ________________________________________________________________

Zip code: ________________________________

Area code: ______ Phone number:________________

E-mail: ________________________________________________________________

Name of item donated: ________________________________

Description of item: ________________________________________________________________

Please provide me with a charitable donation tax receipt: yes no

Approximate fair market value: $________________

Ship items to:________________________________________________________________

________________________________________________________________

________________________________________________________________

DRAW Auction
c/o Rosalee Noble
3 Hance Drive
Charleston, IL 61920