Westward Flow! Donation Form

Please return this completed donation form to The Freshwater Trust no later than JANUARY 18, 2010.

If you would prefer to mail a printed version, please click here to download a PDF.

Date: *

Donor Name: *

Donor Company: *

Street Address: *

Mailing Address (if different):

City: *

State: *

Zip: *

Phone: *

Fax:

Email: *

Send Thank You to (if other than Donor):

List all details, including: Number of people, days/times/seasons available, reservations required, meals included, smoking/non-smoking rental, pets allowed, equipment provided, quantity, color, size, original/print, framed/unframed, any other information or limitations. PLEASE: no items with minimum starting bid, reserve price set by donor, or on consignment.

Item Name: *

Item description for catalog: *

Expiration date:

Donor stated retail value per item: * $

Check one : *

Donor will provide gift certificate. (if a service donation)

The Freshwater Trust will prepare gift certificate. (if a service donation)

Donor will deliver personally, or ship. (if an item donation)

The Freshwater Trust will pick up the donation. (if an item donation)

Contact for pickup/delivery:

Instructions for pickup (if needed):

The Freshwater Trust is a 501(c)(3) non-profit organization. Federal Tax ID Number is 93-0843521. Thank you for helping us restore Oregon’s freshwater health.