Company Name & Contact:

Address:

City, Province, Postal Code:

     Fax:   

Email:

Auction/Prize Item:

Retail Value ($):
(Tax receipts will be provided)

Detailed Description of Item:           (Details to include for artwork:  title, year, artist name, media,
dimensions, etc.):

Please check one or more of the following and submit by Mon Nov 2nd:

Please phone or email me and come and get it from me

YES!  I will deliver it directly to JFCY

Sorry, not this year, but please keep me on your mailing list

Other

We are grateful for your generosity and
your promotion of access to justice!