Leukemia Ball Silent Auction Donation Form

Donor Information:

Donated courtesy of: *

Individual name or company that will be listed on the Mobile Bidding Website.

Donor Address

Address Line 2

City

State

If International, Province or Country

Zip / Postal Code

Donor Phone

Donor Email *

Contact Information:

Contact First Name *

Contact Last Name *

Contact Phone Number

Contact Email Address

Item Information:

Description of item in 40 words*, or less (please include specific details i.e. number of people, specific location; if house/condo, number of bedrooms/bathrooms, etc) *

*Due to space constraints within our electronic bidding system, edits may be made to description

Value of Item *

Required For IRS Purposes

Item Restrictions:

Expiration Date +

Gratuity

Included

Not Included

Tax

Included

Not Included

Certificate *

Provided By Donor

Please Create A Certificate

Item(s) can be packaged with other items *

Yes

No

Other restrictions: (including notes to auction coordinator about item specifics (e.g. how donor would like to be contacted about the winner, etc.)

How did you hear about the Leukemia Ball silent auction? *

_______________________________________________________________________________________________________

Delivery Information:

If unable to email donation, please mail to the below address:

Sadie Caccimelio

3601 Eisenhower Avenue, Suite 450

Alexandria, VA 22206

If you have any questions please contact Sadie at sadie.caccimelio@lls.org.

LLS is a 501(c) 3 organization
Tax ID 13-5644916

LLS RESERVES THE OPTION TO USE AUCTION ITEMS IN OTHER LLS AUCTIONS AS DEEMED NECESSARY