2014 Gifts in Kind
Donor Information (please print or type)
Business Name
Contact Name
Address
City, State, ZIP code
Telephone (business)
E-Mail
Donation Information
Item Description
Quantity
Acknowledgement Information
Please use the following name(s) in all acknowledgements:
____ I (we) prefer to opt out of any UHS published donor lists.
_______________________________________
Signature
For Office Use Only –
Event name:
Cost Benefit:
Gift Account/Appeal Code:
Advance ID
Submitted by (sign/date):
_____________
Date
Fair Market Value