Donate a Bottle of Wine

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Fields marked * require an entry.

We are looking for our GPN families to donate a bottle of red or white wine (valued at $20 and over) for our wine pull.

In the "notes" section - please specify if it is a white or red.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*

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