Wings of Mercy Ball
AUCTION PROCUREMENT FORM

Mercy Care Foundation

Tel. (678) 843-8676 • Fax (678) 843-8679
1100 Johnson Ferry Road, Center 2 • Suite LL80 • Atlanta, GA 30342


Please Submit This Form At Least One Month Prior to the Event

Donor Contact Information

 
Donor Company Name
 
Contact First Name:*
 
Contact Last Name:*
 
Address 1:*
 
Address 2:
 
City:*
 
State:*
 
Zip Code:*
 
Phone*
 
Fax
 
Email Address:*
 
Company Website:
 
 

Donor Name for Catalog

(List exactly as you wish to appear in Auction Catalog)

Donor Name for Catalog:*
 
Item Donated:*
 
Donor Stated Retail Value $*
 
Name of Individual for Thank You
(if Different than Donor/Contact Name)
 
Item Description*

(i.e. color, quantity, size, number of people, etc.) Please be complete as this will be used to write the auction catalog description.

 
Restrictions:

Please state any limitations or special restrictions.
(If field is blank, MCF will assume there are no limitations or special restrictions.)

 
Expiration Date (if applicable):
 
 

Tangible Items

 
For Tangible Items:


 
Tangible Item will be delivered on (date)
 
Tangible Item Requested pick-up week
 
 

Intangible Items

(Donor: Please include any appropriate display materials)
 
Intangible Items


 
Will Provide Certificate Date:
 
 

Cash Donations

 
Cash Donations:

 
 

Gala Invitation List

 
Please add me to the gala invitation list:

 
To prevent spam, please tell us:
What is 0 + 7 ?
 

Accreditation

 
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