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GIFT DONATION FOR AUCTION/YARD SALE
| Name:____________________________________________: |
| Address:______________________________: |
| City:_______________ State: ____Zip:_________: |
| Telephone (home)(___)_____-_____________: |
| Telephone (business)(___)_____-_____________: |
| Fax(___)_____-_____________: |
| E-Mail:_______________________@_________________________________: |
| Description of gift: |
| Acknowledgement Information |
| Please use the following name(s) in all acknowledgements: |
| Name(s)______________________________________________________: |
| I (we) wish to have our gift remain anonymous. |
| Signature(s)______________________________:Date____/____/_______: |
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Items can be delivered to address below or call and we will pick them up. |
KNOX COUNTY CANCER PATIENT FUND
312 Cumberland, Ave.
Barbourville,KY. 40906
(606)545-0171
