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To make a donation to our silent or live auction held on December 2nd please use the form below. Questions about donating? Please contact Max Marlett at 971-322-9004 or max.marlett@providence.org. Thank you for supporting Providence Home and Community Care.

Procurement Form

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:

Work Phone:

Email:*

Procurement Form

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