Donor or Company Name*
Donation Contact Person
Donor Address Line 1
Donated Item Name & Description*
description of item please include expiration dates if applicable.
Retail Value of Donated Item*
I will coordinate delivery of donated item with D.A. Development Dept.
This form serves as the gift certificate
Solicitor's Name & Phone # (if applicable)
Name & Class of D.A. Contact (if applicable)
Please send a confirmation email to the address below: