United Way of Thurston County



Saturday, January 26, 2013 Lucky Eagle Event Center

In-Kind Contribution Form

United Way of Thurston County

Procurement deadline: December 21, 2012

Thank you for submitting this form along with supporting documentation if applicable to:

United Way of Thurston County

1211 Fourth Ave E

Olympia, WA 98506

ITEM NAME:

DESCRIPTION: (Include dates, times, limitations, size, color, features and restrictions).

Fair Market Value (REQUIRED): $ ____________ Expiration Date (REQUIRED): _____________

□ If value to read “Priceless,” check here. The above value will be used only to set bidding range.

□ Physical Item ( Gift Certificate Item ( Physical Item & Gift Certificate

IF ITEM IS A GIFT CERTIFICATE:

□ Certificate is attached

□ Please create a certificate (Donor signature required to create a certificate.)

Donor Information: Please fill out completely.

Donor Name for Catalog:

Contact Name:

Address:

Phone Number: __________________________ Email:

Donor Signature:

Check box if Donor does not wish to be recognized in the catalog. (

To publicly recognize the generosity of those who support projects throughout United Way of Thurston County, donors are listed in the annual report. Please indicate if you prefer your gift to remain anonymous.

United Way of Thurston County is a 501(c) (3) organization. In-Kind gifts to United Way of Thurston County are tax deductible to the extent allowed by law. Please consult with a qualified tax advisor regarding this or other charitable giving to United Way of Thurston County. Thank you for your generous gift!

Solicitor Information: Please fill out completely.

Name: _______________________________ Email:

Home Phone: __________________________ Work Phone: ___________________________

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