14th Annual Radiothon - United Way of Southwest Colorado

Hello and thank you so much for your donation to the 2009 United Way Radiothon. Please complete the following form as completely as possible and someone will be contacting you very soon to verify your donation.

By submitting this form, you (or your company) agree to donate the following item(s) to benefit the United Way of Southwest Colorado and its partner agencies through funds raised during its Four Corners Broadcasting Radiothon on Friday, September 11th, 2009. You also understand the item(s) will be auctioned on the air and may be packaged with others for maximum benefit. Please be as descriptive as possible in order for us to better advertise your business.

If you have more than three items to donate and they are all different, please complete this form and submit it again. If you have more than 3 items and they are similar, you can combine them into one item as necessary in the description section below.

Item marked with an * are required. Again, thank you :)

* Please enter your full name:

Company name (if applicable):

* Company (or personal) Address 1:

Company (or personal) Address 2:

* Company (or personal) City:

* Company (or personal) State:

* Company (or personal) Zip Code:

* Phone Number:

* Email Address:

Web Address:

Would you like us to pick up your item(s)?

Would you us to create a gift certificate?

* Item #1 Name:

* Item #1 Value: $

* Item #1 Description:

Item #2 Name:

Item #2 Value: $

Item #2 Description:

Item #3 Name:

Item #3 Value: $

Item #3 Description:

Total Number Of Items:

Total Value Of Items: $