The 2nd Annual Sebastian’s RunWalk for a Cure Donation Form

Donor's Name: ____________________________________

Company Name: ___________________________________

Address: _______________________           ZIP:__________

Phone: _____________________________________ Web-site: ____________

If you are making a monetary donation, please complete the following (you can either fax or mail):

 $250,00         $500,00        $ 1,000.00         $ 2,500.00             Other:________

Card Number: _______________________ Exp Date: _____

Signature of Donor: ___________________________________

Please complete with description of item/service you are donating:

Please provide the Retail Value of Item or Service Donated:$________

If you are donating merchandise or service for Sebastian's RunWalk for a Cure, please include contact and phone number:

Name:___________________

Phone:___________________

Date item(s) are available for pick up: __________________

Date donor will deliver item(s) to Mt Laurel: __________________

If you are donating an item or service for Sebastian's RunWalk for a Cure, a committee volunteer will be in touch with you as soon as we get the completed form.

Please mail the document to this address below or if you have questions, please call Sarah Hodo at 205.382-5430, e-mail sebastiansrunwalk@gmail.com