Nutty Nutcracker Auction Donation Form

The Leukemia & Lymphoma Society’s 3rd Annual Nutty Nutcracker Sunday, December 13, 2009 Presented by Xtreme Dance Studio at Lake Mary Performing Arts, Lake Mary AUCTION COMMITMENT FORM Thank you for your support of the 2009 Nutty Nutcracker fundraiser! Please complete all sections of this form to ensure donation receipt and representation of your company’s name on all Nutty Nutcracker auction materials.

-Donor InformationDonation Courtesy of: (Individual name or company name that will be listed in the Nutty Nutcracker Auction Guide). __________________________________________________________________________________________________ Contact Name: ______________________________________________ Title: _________________________________ Address: __________________________________________________________________________________________ City: _________________________________________________ State: ___________ Zip: _____________________ Phone: ________________ Fax: _________________ Email: ______________________________________________

-Item InformationDescription of donated item: __________________________________________________________________________________________________ Estimated “Fair Market Value” of item: ___________________________ Please list any restrictions, expiration dates, etc of item: ______________________________________________________ __________________________________________________________________________________________________ Please check all that apply: Donated item enclosed.

Please contact me about pick up of item.

Item will be delivered on __________________ (fill in date)

Displays, brochures or promotional visuals are included with item.

-Important InformationDELIVERY INFORMATION – ALL DONATIONS MUST BE RECEIVED BY DECEMBER 4th Thank you in advance for your donation, which will enhance the future quality of life of many patients and families affected by one of the blood cancers. The Leukemia & Lymphoma Society Federal Tax ID: 13-5644916 Your donation may be deductible. Please ask your tax advisor to see if you qualify.

PLEASE COMPLETE AND RETURN THIS FORM TO: SHERI METCALF – XTREME DANCE STUDIO 4932 W SR 46, SUITE 1048 ▪ SANFORD, FL 32771 ▪ 407-330-7002 ▪ [email protected] OR

MARY HEALEY – THE LEUKEMIA & LYMPHOMA SOCIETY 3319 MAGUIRE BLVD., STE. #101 ▪ ORLANDO, FL 32803 ▪ 407-898-0733 ▪ [email protected]