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Auction Donations Contact: Lori Byars c/o Chicago House 1925 North Clybourn, Suite 403 Chicago, IL 60614 Email: lbyars@chicagohouse.org Phone: 773-248-5200, x209 Fax: 773-248-5019

Thank you for your donation to

The 2014 Birdhouse Auction and Cocktail Party! Federal ID Number: 36-3376432

Tax Exempt Number: E9991-7971-04

Designer: ____________________________ Contact Person: _________________________ Address: _____________________________________________________________________ City: __________________________________ State: _____________ Zip: _______________ Email : _____________________________ Phone: _______________ Fax: ________________

List as Anonymous?

Yes

No

Item is:

Artwork

Other Auction Item

Title of Donation: ______________________________________________________________

Value of Donation: ______________________________________________________________

Dimensions and Description: ______________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Special Instructions: _____________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

My item is enclosed. My item will be delivered on: _________________________________ (Deadline is June 4th)

Please include completed copy of this form and .jpg or .png image with your submission. ____________________________________

______________________________________

Donor Signature

Chicago House Committee Member Signature

______________________________________ Date Contributions are deductible for income tax purposes to the extent allowable by law.

birdhouse-2014-artist-form  
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