Exit Auction Donation Form for Temple Shalom Saturday, June 9, 2018 Question Title * 1. Donor's name Question Title * 2. What is your address for the tax receipt? Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Question Title * 3. Please describe your donation in as much detail as possible. Question Title * 4. Estimated Value of Donation Question Title * 5. Restrictions, limitations or other information about donation Question Title * 6. Please mail/deliver your donated item to Temple Shalom, c/o 2018 Auction, 8401 Grubb Road, Chevy Chase, MD 20815. If your item cannot be mailed or delivered, please let us know below how we can obtain it. If you would like Temple a Shalom to create a certificate, please state "Create Certificate." Question Title * 7. I would like to be contacted about making a monetary sponsorship donation, which will be acknowledged in the event materials and include an advertisement or other message in our auction catalog. Yes No Done