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SILENT AUCTION DONATION RECEIPT FORM
Donated Items/Service
______________________________________________________________________
Donor’s Name
_____________________________________________________________________
Advertiser’s Name for Acknowledgement Conference Publication
Contact Person
______________________________________________________________________
Address
______________________________________________________________________
City/State/Zip/Country
Phone _(____)____________ FAX _(____)_______________ E-mail ______________
Description: Item _ Service _ (for the auction catalog – please include any restrictions or
minimum bid)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Please include a business card, brochure, newspaper reviews, photograph, or other information
that we may use to promote your item or your business, to be displayed with your donation, which
could optimize the successful sale of your donation that benefits those we serve at the Bergen
Family Center.
Estimated Market Value of donation $ ____________ Do you wish to set a minimum bid?
$______________
PLEASE CHECK ONE
□ Item is a service, so enclosed is a certificate of services to be provided.
□ Item(s) need(s) to be picked up. Address (if different from above):____________________________
□ Item(s) will be delivered/shipped in advance to: Ed Choi (50 lb limit per box) to be received
at: 44 Armory Place, Englewood, NJ 07631 201-568-0817
Donor’s Signature __________________________Date _____________________
Please sign and either email form to echoi@bergenfamilycenter.org or fax form to
Edward
Choi - 201.568.0913
Many thanks for your donation. Your generosity makes a difference. Proceeds go to
infants, children, youth, and older adults served by the Bergen Family Center.
Bergen Family Center is a 501 (c)3 organization. All donations are tax deductible. Federal Tax ID #22-1487611