Item Donation

Fields marked * require an entry.

2024 Drive A Thon

Thursday, August 22, 2024

Item Information

Item Name:*

*Please enter a value

Estimated Value $:*

*Please enter a value
Please enter a valid decimal number as nnn.nn

Donor name (as it should appear in the catalog):*

*Please enter a value

Item Description:*

*Please enter a value

Restrictions (expiration date, age restriction, etc.):

I am a(n):*

Individual Donor

Business Donor

*Please enter a value

I would like to remain anonymous:*

Yes

*Please enter a value

Delivery/pick-up details:*

Item needs to be picked up

Item will be mailed or delivered

N/A—certificate to be created by Goodtimes

*Please enter a value

Certificate details:*

Physical item—no certificate

Donor to provide certificate

Goodtimes to create certificate

*Please enter a value

Contact Information

Company:*

Please enter a value for Company:

First Name:*

Please enter a value for First Name:

Middle Name:

Please enter a value for Middle Name:

Last Name:*

Please enter a value for Last Name:

Address:*

Please enter a value for Address:

Address2:

Please enter a value for Address2:

City:*

Please enter a value for City:

State:*

Province State is required for the United States

Postal Code:*

Please enter a value for Postal Code: Please enter a valid postal code.

Country:*

Country is Required

At least one phone number is required.* Please enter at least one phone number

Mobile Phone:

Please enter a value for Mobile Phone: Please enter a valid phone number. Use x to denote extension

Work Phone:

Please enter a value for Work Phone: Please enter a valid phone number. Use x to denote extension

Email:*

Please enter a value for Email: Please enter a single valid Email.

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