Item Donation

Fields marked * require an entry.

Rotary CAPER relies on the generosity of organizations and

individuals just like you.

The goods and service you donate will help us help others.

Just use this simple form to submit your items online!

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

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:*