Name as it should appear in the catalog:
 

Contact name (if different from above) 

Address

City         Zip

Phone     Fax

Email address

Item Name

Donor's Estimate of Retail Value:

Item description (Please specify quantity, color, size, number of people,
dates available, exchangeable, assembly required, etc., etc.)

Item restrictions (Distance? size?  Number of people? 
Expiration date other than the standard September 12, 2009?  Blackout date?)

Item to be picked up.  If yes, please answer the following:
          at this location 
          by this person  
          on this date     

Donor will provide display materials

List display materials that MUST be returned to donor: