Auction Item Procurement Form

Also use this form for sponsorship selection, purchasing tickets/table, and ordering catalog ads. Complete applicable portion(s) and required fields.

Click here for a printable version of the procurement form.

PROCUREMENT FORM DEADLINE: MARCH 12

CATALOG DEADLINE: MARCH 12

You must complete and submit the form below no later than March 12 to ensure the item is featured in the auction catalog.

PLEASE COMPLETE A NEW FORM FOR EACH ITEM!

ROTARY MEMBER/AUCTION REPRESENTATIVE

First Name (REQUIRED)

Last Name (REQUIRED)

Email Address (REQUIRED)

Repeat Email Address (REQUIRED)

Team

Daytime Phone

DONOR INFORMATION

Donor or Company Name

AS IT SHOULD APPEAR IN CATALOG

Donor Contact Name (if different than above)

Donor Address

 

Donor City

 

Donor State

 

Donor Zip

Daytime Phone

Fax Phone

Email Address

GIFT INFORMATION

Gift Item Name

Value (REQUIRED)

Donor estimate of fair market value

 

Gift Item Description

Please specify color, size, quantity, number of people, dates
available, if exchangeable, if assembly required, etc.)

 

Gift Item Restrictions

Please specify all restrictions.

Expiration Date (MM-DD-YY)

Please check all that apply to gift item.

	Tangible Item - Displayed at Auction
	Tangible Item - NOT Displayed at Auction
	Intangible Item
	Donor to Provide Promotional Material
	Donor to Provide Gift Certificate
	Auction Committee to Create Certificate
	To Be Delivered By Donor

 

SPONSORSHIP LEVELS

Please make SPONSORSHIP SELECTION by selecting the appropriate button.
 

	Title Sponsor - $25,000
	Platinum Sponsor - $10,000
	Gold Sponsor - $5,000
	Silver Sponsor - $2,500
	Table for 10 - $1,750
	Tickets-Single - $175

 

ADVERTISEMENT

Please make ad selection below.
 

	Full Page ... 6.5" Wide x 10" High ... $1,750
	Full Page with bleeds ... 7.5" Wide x 11" High + 1/8" bleeds ... $1,750
	Half Page ... 6.5" Wide x 4.875" High ... $1,000
	Quarter Page ... 4.875" Wide x 3.125" High ... $600
	Business Card Size (1/8th page) ... 3.125" Wide x 2.25" High ... $250

TOTAL AMOUNT OWED (REQUIRED)

PAYMENT METHOD

	BILL MY ROTARY ACCOUNT
	CREDIT CARD If paying by credit card, you can pay online on the next page (payments processed through PayPal's secure servers), or you can phone or fax your credit card information to Auction Coordinator Barb Bender, Ph 206-522-6073, Fax 206-327-9558.
	CHECK If paying by check, please make checks payable to "Bellevue Rotary Foundation" and mail to: Barb Bender, Auction Coordinator, PO Box 523, Bellevue, WA 98009

DELETE THE TEXT IN THE FIELD BELOW
The field below must be empty or the form cannot be processed. This is a spam protection measure.

YES! Please send me an auction invitation!

Fed Tax ID: 91-1501333
Your donation may be tax deductible. Please check with your tax advisor to see if you qualify.

 

 

 

 
 

Bellevue Rotary would like to give special recognition and thanks to American Family Insurance, our Title Sponsor for the 2010 Bellevue Rotary Auction.