Honoring Permanent ID#______________ Package with # ______ Final Package ID# ______ Final Package Total $ ________
Final Sequence # Catalog # 3x5 TY Sent GC Item Recd.
Pete & Wendy Ernaut Gala Chairs Jim & Carol Bauserman April 24, 2010
Northern Nevada JDRF ~ 5335 Kietzke Lane, Suite 230 ~ Reno, NV 89511 ~Tel. (775) 786-1881~ Fax (775) 827-0131 PROCUREMENT DEADLINE FOR FORMS IS: FRIDAY, MARCH 24th Earlier would be most appreciated! Donor Name/Company
Donation (describe in brief)
Donor Name As You Would Like it Listed in Catalog
Contact Name & Phone for Arrangements or Follow Up
Address
Name of Individual for Thank you letter if Different than Donor
Phone
Fax
Donor Stated Retail Value:
Describe Donation In Detail. This description will be used for the catalog. Please be complete. (i.e. color, quantity, size, number of people, etc.)
Restrictions: Please state any limitations or special restrictions.
This is a Tangible Item to be Displayed at Auction: (Donor: Please include any appropriate Display Materials)
This is an Intangible Item: (Donor: Please include any appropriate Display Materials)
JDRF Tax-Exempt Item accompanies donor form
Certificate accompanies donor form
I will deliver to JDRF before April 16th
I will provide certificate by April 12, 2010
Please pick up my donation the week of April 12, 2010
JDRF has my permission to create a certificate
This is a Cash Donation Check Enclosed Signature of Donor
#23-1907729
Gala Invitation Requested Yes Signature of JDRF Representative
No