Item Donation

Fields marked * require an entry.

Please submit this form when you are ready to deliver your procured item(s) or service(s) to ICOLPH School. The procurement deadline is Friday, March 9th, 2012.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Email:*