Fields marked * require an entry.

Greetings Rotarians! In completing the form below,

Please complete the form as if you are the Item Donor;
if you don't have the address or contact information for the donor, write "IDK." The Donor name (business or first/last) is very important;
provide a complete and persuasive description of the item in the "Item Description."

Thank you! Your Escapades Committee

Procurement Form

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Additional Information:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Item Restrictions:

Item solicited by:

Gift Certificate Status:

Procurement status:

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:

Address2:

City:

State:

Postal Code:

Country:

Mobile Phone:

Home Phone:

Work Phone:

Email: