Galpin Motors Golf Classic

Monday, September 22, 2008


Donor Name:	*
Address:	*
City:	*
State:	*
Zip:	*
Telephone:	*
E-mail:	*
Fax:
Description of Donation Item (175 items requested for tee gifts):	*
Fair Market Value:	*
Restriction & Timeliness:	*
Delivery Information:	*
Additional Information:
Contacted by (Name of The Heart Foundation Member if applicable):

Please direct all questions to Auction Coordinator Suzi Kokenda at (818) 344-4567

After submitting this form, Auction Coordinator Suzi Kokenda will contact you to arrange the pick-up or delivery of your donation.

Thank you for your support. Permit to solicit charitable contributions on file. The Heart Foundation is a 501(c)(3) non-profit organization. Our tax ID # is 45-0471117.