Mail, FAX, or email this form to: HCCA - Kortney Nordrum. America's Fund Silent Auction. 6500 Barrie Road, Suite 250. Mi
SILENT AUCTION DONATION FORM HCCA for America’s Fund Please return this form or email the information to Kortney Nordrum by March 1, 2015. Mail, FAX, or email this form to:
HCCA - Kortney Nordrum America’s Fund Silent Auction 6500 Barrie Road, Suite 250 Minneapolis, MN 55435 FAX: 952-988-0146
[email protected]
Silent Auction items listed below must be delivered to HCCA by March 1, 2015
Donor Representative Name: Donor Company Name: Mailing Address: Physical Address: Email and Phone Number: Description of item or service being donated:
Approximate Retail Value (US Dollars):
If you’d like an official logo printed included on the donation, please email a high-res image (300 dpi minimum) to
[email protected]
Thank you for your support!
