RAPE RESPONSE SERVICES 
                  
         20th Anniversary Annual Auction and Awards Night

                              Auction Item Donation Form

                                                 Your donation is greatly appreciated!!!

The item(s) is being donated by:

Name: _________________________________________________________________

Business/Organization:  __________________________________________________

Phone/E-Mail: __________________________________________________________

Please list the item(s) that is being donated:

Item Name/Description                                                                                 Estimated Value

1. __________________________________________________________            $________

2. __________________________________________________________           $________

3. __________________________________________________________           $________

Please check the line that is appropriate:

____ My item(s) is ready for pick-up now.

____ My item(s) will be ready for pick up on this date: _____________

____ Item will be shipped on this date: ____________.  Please ship to Rape Response Services,

262 Harlow Street, Bangor ME 04401

If appropriate, please tell us where to pick up the donation:

_________________________________________________________________

                 PLEASE FAX THIS FORM TO 207-973-3699 OR E-MAIL TO krobertsfer@penquis.org

                                                              AS SOON AS POSSIBLE.

                                                  THANK YOU FOR YOUR SUPPORT! 

                                    Please call Kim Roberts-Fer at 973-3633 with any questions.