Silent Auction Donation Form

Please complete this form if you are donating to our silent auction. Due to the virtual format of this conference and auction, you are responsible for any shipping costs and logistics for delivery of item to the winner. Thank you!

Kids’ Chance of Ohio
Federal Tax Number 26-0216888

Donor's Full Name (name to be recognized): *
Contact Name: *
Company (If applicable):
Donor's Physical Address: *
City/ST/Zip: *
Phone: *
Email: *
Donation Description (use separate forms for each donation; be very detailed) *
Retail Value: *
Cash donation amount (if donating cash):
Attachment (If you have a document to support this donation, attach here):
Please upload your company logo so we can properly recognize your donation. *



Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

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PO Box 1073 | Columbus, OH 43216 | info@ohioselfinsurers.org | 614-340-3530
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