Procurement Form - Home - Team Survivor...
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Donation Form Annual Gala An event benefiting Team Survivor Northwest The mission of Team Survivor Northwest is to support women in their cancer recovery through empowering programs of physical activity and health education. October 19, 2013 at the Bellevue Hilton DONOR INFORMATION (please print legibly) Please have items turned in by Sept. 1 Name:_______________________________________________________________________________ Title: _______________________________________________________________________________ Name of donor to be displayed at event: ___________________________________________________ Company Name:_______________________________________________________________________ Address: ____________________________________________________________________________ ____________________________________________________________________________ City State ZIP Daytime Phone:_________________________________Website:________________________________ Email: ______________________________________________________________________________ INFORMATION ON ITEM DONATED Description of donated item(s): (Please include restrictions/expiration dates) ____________________________________________________________________________________ ____________________________________________________________________________________ Value of donation(s): $__________________ Is item/certificate enclosed? YES NO Does committee need to create a gift certificate? YES NO If item is not enclosed, please provide instructions for pick up or delivery of item : ____________________________________________________________________________________ Signature of Donor:___________________________________________ Date:____________________ Procurer Name and Phone Number:_______________________________________________________ PLEASE RETURN FORM TO: Team Survivor Northwest • 200 NE Pacific St #101 • Seattle, WA 98105 • FAX: 206-732-0263 (Please fill out the section below, detach, and give to the donor for their tax records.) Team Survivor Northwest 2013– Donor Receipt Donated Item:__________________________________ Value:_________________________________
Transcript of Procurement Form - Home - Team Survivor...
Donation Form
Annual GalaAn event benefiting Team Survivor Northwest
The mission of Team Survivor Northwest is to support women in their cancer recovery through empowering programs of physical activity and health education.
October 19, 2013 at the Bellevue Hilton
DONOR INFORMATION (please print legibly) Please have items turned in by Sept. 1
Name:________________________________________________________________________________
Title: _______________________________________________________________________________
Name of donor to be displayed at event: ___________________________________________________
Company Name:_______________________________________________________________________
Address: _____________________________________________________________________________
_____________________________________________________________________________ City State ZIP
Daytime Phone:_________________________________Website:________________________________
Email: ______________________________________________________________________________
INFORMATION ON ITEM DONATED
Description of donated item(s): (Please include restrictions/expiration dates)
_____________________________________________________________________________________
_____________________________________________________________________________________
Value of donation(s): $__________________ Is item/certificate enclosed? YES NO
Does committee need to create a gift certificate? YES NO
If item is not enclosed, please provide instructions for pick up or delivery of item :
_____________________________________________________________________________________
Signature of Donor:___________________________________________ Date:____________________
Procurer Name and Phone Number:________________________________________________________
PLEASE RETURN FORM TO:Team Survivor Northwest • 200 NE Pacific St #101 • Seattle, WA 98105 • FAX: 206-732-0263
(Please fill out the section below, detach, and give to the donor for their tax records.)
Team Survivor Northwest 2013– Donor Receipt
Donated Item:___________________________________ Value:_________________________________
Your donation is tax deductible under IRS 501(c)(3). Team Survivor Northwest’s tax ID is 91-1743945. Please visit Team Survivor Northwest at www.teamsurvivornw.org.
