Procurement Form

Your First Name (required)

Your Last Name (required)

Your Email (required)

Your Phone (required)

Company/Donor Name (for catalog acknowledgement)(required)

Street Address

Address Line 2

City

State

Zip

Donation Value (required)

Description of Item (required)

Item Restrictions (required)

Expiration date, number of people, blackout dates, etc. All items will expire one year from date of auction (11/2/2020) unless otherwise noted.

Certificate Item ONLY
Certificate to be mailed by donorCertificate to be created by Bellevue LifeSpring

Tangible items ONLY
To be mailed or dropped off by donorPlease contact me to arrange pickup