2015 SILENT AUCTION DONATION FORM
Blast from the Past
Friday, April 24, 2015
Remington Park
THANK YOU FOR YOUR DONATION!
To be included in the Blast from the Past Silent or Live Auction, this form must be received by Friday, April 10,
2015. Thank you for cooperating with our printing deadlines. Your contribution is truly appreciated.
(Please Type or Print)
Donor Name:__________________________________________________________________________
(Please provide donor name as you would like it to appear in printed materials)
Contact: ______________________________________________________________________________
Donor Mailing Address:__________________________________________________________________
Donor City, State and ZIP:________________________________________________________________
Donor Telephone Number (include area code):_______________________________________________
Donor Fax number (include area code):_____________________________________________________
Donor E-mail Address:___________________________________________________________________
Detailed description for the silent auction (quantity, size, color, condition, restrictions, or other information to
ensure proper understanding of the item(s):
Promotional & Marketing Materials with Props are needed to help get the highest bid for your donated item.
These items will be returned to you after the event.
Expiration Date (if applicable):____/____/____
If donation is a gift certificate, one year is preferred.
Fair Market Value (The IRS requires us to provide to the buyer): $______________
Does the donor wish to remain anonymous?
Is metro area pick up service needed?
Yes
 Yes
No
No
If so, pick-up Location_____________________
If donation is a gift certificate:  It is enclosed with the contract
 ESOK should create one
Donor Signature:_____________________________________________Date:______________________
Please mail completed form to:
Easter Seals Oklahoma
Attn: Karisa Rollins
701 NE 13th Street
Oklahoma City, OK 73104
Or fax:
Easter Seals Oklahoma
Attn: Karisa Rollins
405-239-2278
Or email:
Karisa Rollins
[email protected]
Questions? Contact Karisa Rollins, Development & Marketing Director at 405-239-2525
Tax ID Number: 73-0580276
For Office Use:
Solicitor Initials ______________Date Rec.__________________Gift ID________________Package ID_______________________