Silent Auction Donation Form

Our Second Project: The Grove Street Houses

Mail to:	Irene Bacchi Beautiful Home/Grove Street Birch Family Services 104 West 29^th Street, 3^rd Floor New York, NY 10001	Fax to:	(212) 741-6896 To: Irene Bacchi
Instructions: Fill in the fields on this page— required fields are noted with an asterisk (*) — then… for a receipt, print the page when ready. click on the ‘Donate Now’ button to complete your donation.

I would like to donate products or services for the Grove Street Houses Silent Auction on October 7… Donor:
First name:*		Last name:*
Business name:		Email address:*
Mailing address:*		Apt or Suite:
City/Town:*		State:*	Zip:*
Phone (day):		Cellphone:
Name of donated item:*
Description of item:*
Year (for antiques, wine, whiskey, etc.):
Wholesale price:	$	Retail price:	$
Other details (include references to autographs, previous owners, etc.):

For more information, please contact at (212) 616-1807.
NOTE: Ms. Bacchi will contact you to coordinate delivery and acknowledgement.