Fields marked * require an entry.

**Please complete on behalf of the donor & state the name of the individual completing this form in the notes section**

GSofSI Item Donations

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Additional Details & Volunteer Name:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

I will mail item(s) to GSofSI office (4 Ginger Creek Pkwy. Glen Carbon, IL):

Yes

I will drop item(s) off at GSofSI office.:

Yes

I will email certificate to Development Office (hkoehlweaver@gsofsi.org):

Yes

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:*