Item Donation Form

Company Name:

* Contact Name:

* Address:

* Phone Number:

* Email Address:

Item/Business Website:

* Item Name:

* Detailed Description (including qty., size, color, etc.):

Restrictions and Conditions (Use by certain date, weekdays only, etc.):

* Item Value:

* Delivery Instructions: Please have a DVSAS representative pick up the item. Donor will send/deliver item to DVSAS.

If item is not tangible and needs a gift certificate created: Please have DVSAS make gift certificate for item. Donor will supply gift certificate for item.