IN-KIND DONATION FORM

• Contact Information

• Donor Name*
  (as you would like to be listed)
  First
• Contact Name*
  First
• How did you hear about Bank The Blue's Gala?
• Address
  Street Address City State / Province / Region ZIP / Postal Code
• Email*
• Phone*
• Item/Service to be Donated*
• Date/Time of Service or Delivery*
  MM slash DD slash YYYY
• Time*
  : Hours

  Minutes

  AM PM AM/PM
• Estimated Total Value $*
• Additional Details

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