Please enable JavaScript in your browser to complete this form.Donor InformationPlease enter the following information to submit a Gala Auction Donation item/experience for consideration for the September 21st, 2024 Habitat Gala.Your name *FirstLastPlease enter your name or the name of the primary contact person for this auction item donation.Company Name (if applicable)Phone *Cell phone or best contact numberEmail *Donor name(s) (as you would like it to appear on the program)Company or individual. If multiple donors involved in this item, please list all names that should appear.Please check if you wish to remain anonymousAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDonation Information (Please add a detailed description of the donation) *Photos/Visuals of Auction Item (Please share any relevant photos of the auction item/experience. If this item is donated by a business, please include your company's high-res logo in this section as well) Click or drag a file to this area to upload. Click or drag a file to this area to upload. Click or drag a file to this area to upload. Click or drag a file to this area to upload. Fair Market Value *Please list the Fair Market Value of this item/experience. The Fair Market Value is what this item would traditionally sell for. If no associated value, please type NAExpiration Date *If this item must be redeemed by a certain date, please share when it would expire for redemption. If no expiration date, please type NA.Restrictions/Blackout dates (if applicable) *If there are booking restrictions/blackout dates for when this item cannot be redeemed (such as for a vacation or type of experience), please list those restrictions here. If no restrictions, please type NA.Redemption Instructions: *How the auction item winner will redeem this item/experience? Who will they contact and what should they do?Item Delivery *I will deliver or ship this item to HabitatI will need this item picked up (must be available for pick-up at least two weeks before event and within 35 miles from the Habitat offices)N/A no tangible item (Habitat can generate a certificate)Habitat Staff or Volunteer ContactPlease enter a name of a Habitat staff person or volunteer who you have been in contact with regarding this auction item (if applicable). If no restrictions, please type NA.Signature of Donor Clear Signature Please sign this form. Donation deadline is August 10, 2024. A member of our team will be in touch within 7 days. Submit