Go Western 2023 - General Donation Form

Go Western 2025 - Item Donation Form
Donor/Company/Organization Name
Name to be Printed for Recognition Purpose
Person to Contact

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
Phone Number
Please enter a valid phone number.
Signature

Clear
Date

MonthDayYear
Date
ITEM INFORMATION
Name of Item or Service Donated
If this Item is a Trip or Vacation Home, can it be doubled (Auctioned Twice)
Item Description (include relevant website address - if applicable)
You can optionally upload a digital copy of your certificate (image or pdf)

Cancelof
Item Restrictions (Please be specific with dates & no. of persons)
Expiration and/or Valid Dates - if applicable
Estimated Market Value ($)
Suggested Starting Bid ($)
DELIVERY or PICK-UP

Below indicate any specific pick-up instructions. Contact Martha Martinez to coordinate any pick-up at martha.martinez@westernacademy.net or mail the item directly to the address below.

Western Academy
1511 Butlercrest St.
Houston, TX 77080
Thank you for making a donation to Western Academy.

If you have any questions you may reach out to Mrs. Martha Martinez at Martha.Martinez@westernacademy.net or via phone at 713-461-7000

1511 Butlercrest Street, Houston, TX 77080
TAX ID NO. 26-18866794
Should be Empty:

Go Western 2025 - Item Donation Form