Donate an Item or Package to the Heart Ball

Thank you for your interest in donating to our auction. Please fill out the form below and a staff member will get back to you to confirm your donation details.

Item Information

Item Name:*

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Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor
Business Donor

I would like to remain anonymous:*

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Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country:*

At least one phone number is required.*

Mobile Phone:

Work Phone:

Email:*

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