Donate an Auction Item

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Fields marked * require an entry.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes (item restrictions, instructions for pick-up/drop-off):

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

At least one phone number is required.*

Mobile Phone:

Work Phone:

Email:*

If you have any questions about registering for the PROVAIL Gala, please contact Jillian Whitehill at 206-826-1033 or jillianw@provail.org.