Donación en especie

Please select a purpose for your donation (if unsure, select "general")
Brief description of donation*
Estimated retail value of donation*
Please enter a number greater than or equal to 1.
Date Dropped Off
MM slash DD slash YYYY
Hidden
Estimated retail value of donation*
Donor name*
Name of business contact, if applicable
First Last
Phone
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Will you be providing a physical item or certificate to DCAC (for raffle only)?
- Yes
- No
- No, but DCAC can create a certificate on my behalf

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