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Please fill out the below form completely, include a description, list of items in package, and any restrictions.

Once form completed please deliver your item to Jesse Merriam

Questions ? Contact Jesse Merriam at reigndonations@outlook.com

Donate an Item or Experience

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:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*