Montgomery County Heart Ball Auction Donation Form

Montgomery County Heart Ball

Auction Donation Form

February 22, 2025

Donor Name*

As you would like it printed for publication

Mailing Address*

City/State*

Zip Code*

Donor Contact*

Contact Phone*

Contact Email*

Item or Service you will donate*

Detailed description of Item or Service*

Retail Value of Item/Service*

(The IRS requires AHA to provide value to buyer)

List any restrictions buyer should be aware of

Expiration Date

Please date Gift Certificates February 22, 2025, and allow a minimum of six months to redeem, one year preferred.

Item Status*

Ready for Pickup by date below

AHA Please print certificate

Item Pickup Date

Donor Signature*

By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

Today's Date*

Auction Committee Member Name*

Name of committee member who is helping you with your donation.

File Upload

Please upload photos of your item, and/or photos that will promote your donation along with your logo if applicable.

Drag and drop files here or

Donation Deadline: December 16, 2024

Lisa Fenley - Development Director

LIsa.Fenley@Heart.org

(832) 918-4007

Thank you for your tax-deductible contribution and your support in the fight against the nation's number one killer, cardiovascular disease.

Our Federal Tax ID # is 13-5613797.

Send me a copy of my responses