ITEM DONATION

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Fields marked * require an entry.

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

NDSCS please create certificate:

Yes

No

I will deliver by 3/8/21 or NDSCS please pick up (provide date and time):

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*

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