Fields marked * require an entry.

Thank you for your auction item donation! Please complete the form below and include:

Your contact information
A brief description of the item. Include any restrictions (age, event date, expiration date).
The optional notes section may be used for any instructions for the auction committee such as item delivery or pick up.

The item donation deadline is Friday, February 15, 2019.

Donate an Item

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

Delivery instructions:

I will deliver item to CHA front office

Please contact me to pick up item

If the donation is a gift certificate or service:

I will supply gift certificate

CHA will create a certificate with information on this form

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:

Email:*