Rotary Club of Norwich

"Rotary Gives" 3^rd Annual Charity Auction

March 19, 2010

Donor's Name: __________________   Business Name: _______________________________

Contact Person:  _______________                         Phone:  ___________________________

Address:  ______________________                Email:  ________________________________

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Auction Item Description:                                                                                              Estimated Donated Value: 

___________________________________________________________    $  __________________

___________________________________________________________    $  __________________

____________________________________________________________  $  __________________

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Auction Catalog Advertisement:  (   ) Full Page $175    (   ) ½ Page $125   (   ) ¼ Page $75

Ad Copy Attached?  (   ) Yes           (   ) No         

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Auction Night Dinner:           # of Attendees @ $45  ______         =  $ __________

Table of 10 @ $400                  =  $ __________

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Auction Event Sponsorships:                  (   )  Meat Carving Station $500

(   )  Seafood Station $450                           (   )  Passed Appetizers $400

(   )  Dessert Table $350                           (   )  Pasta & Salad Station $300                 

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Payment Type:            (   ) Cash         (    ) Check #________                                    Total $ ________

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Payment in the amount of $ _______ has been received.  A copy of this form will be mailed upon request. 

The Norwich Rotary Foundation, Inc. is a nonprofit organization under Section 501c3 of the IRS Code, Federal ID # 06-1382089.  Donations to the Norwich Rotary Foundation, Inc. are tax deductible to the fullest extent permitted by law. Certificate of Donation:  I understand all donations become the property of the Norwich Rotary Foundation, Inc. upon issue and authorize them to be used as a means to raise funds to support the Norwich Rotary Foundation, Inc. and its charitable efforts.  (Gift certificates are valid for one year from the date of auction unless otherwise noted in item description above.)We are in receipt of your donation as shown above and will provide a copy of this complete form upon request for your tax records if necessary.

________________________                              ___________________________________

Donor Signature        Date                     Rotarian Signature                                          Date