The Leukemia & Lymphoma Society’s

3rd Annual Nutty Nutcracker

Sunday, December 13, 2009
Presented by Xtreme Dance Studio at
Lake Mary Performing Arts, Lake Mary
AUCTION COMMITMENT FORM
Thank you for your support of the 2009 Nutty Nutcracker fundraiser! Please complete all sections of this form to ensure
donation receipt and representation of your company’s name on all Nutty Nutcracker auction materials.

-Donor Information-
Donation Courtesy of: (Individual name or company name that will be listed in the Nutty Nutcracker Auction Guide).
__________________________________________________________________________________________________

Contact Name: ______________________________________________ Title: _________________________________

Address: __________________________________________________________________________________________

City: _________________________________________________ State: ___________ Zip: _____________________

Phone: ________________ Fax: _________________ Email: ______________________________________________

-Item Information-
Description of donated item:
__________________________________________________________________________________________________

Estimated “Fair Market Value” of item: ___________________________

Please list any restrictions, expiration dates, etc of item: ______________________________________________________

__________________________________________________________________________________________________
Please check all that apply:
Donated item enclosed. Please contact me about pick up of item.
Item will be delivered on __________________ (fill in date) Displays, brochures or promotional visuals are included with item.

-Important Information-

DELIVERY INFORMATION – ALL DONATIONS MUST BE RECEIVED BY DECEMBER 4th

Thank you in advance for your donation, which will enhance the future quality of life of many patients and families affected by
one of the blood cancers.

The Leukemia & Lymphoma Society Federal Tax ID: 13-5644916

Your donation may be deductible. Please ask your tax advisor to see if you qualify.

PLEASE COMPLETE AND RETURN THIS FORM TO:

SHERI METCALF – XTREME DANCE STUDIO
4932 W SR 46, SUITE 1048 ▪ SANFORD, FL 32771 ▪ 407-330-7002 ▪ XTREMEDANCE@MSN.COM
OR
MARY HEALEY – THE LEUKEMIA & LYMPHOMA SOCIETY
3319 MAGUIRE BLVD., STE. #101 ▪ ORLANDO, FL 32803 ▪ 407-898-0733 ▪ MARY.HEALEY@LLS.ORG