Silent Auction & In-Kind Donations

Fields marked * require an entry.

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

Please email your logo and any applicable documentation (gift certificates, letters, flyers, etc.) to ldelancey@epiny.org

How should we collect your donation?

We will email it to you at ldelancey@epiny.org

We will mail it to you at EPI, 1650 South Ave., Rochester, NY 14620

We will drop it off at EPI, 1650 South Ave., Rochester, NY 14620

Needs to be picked-up

None of the above, I will explain below.

Please list any special instructions for pick up and/or receipt of your donated items:

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:

Work Phone:

Email:*