Silent Auction Contributor Form

Silent Auction Contributor Form
Thank you for supporting the Pennsylvania Foundation for Home Care and Hospice by donating an item to our Silent Auction! Please complete the form below with information about your donation. This information will help us accurately describe and promote your item to bidders.

Please complete one form for each auction item donated. Please contact Michaelene Licht (mlicht@pahomecare.org) with any questions.
Contributor Information
Individual or Company Name
Street Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Donation Details
Description of Item
Contribution Dollar Value ($)
Preferences
Donors will be recognize through the online auction platform. Please check the box if you prefer your donation to be anonymous.
Please upload a high-resolution image of your organization's logo to be included on the online auction platform (if applicable).

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Acknowledgment
By submitting this form, I acknowledge that I am donating the item described above to the Pennsylvania Foundation for Home Care and Hospice (Foundation) for inclusion in its Silent Auction. I agree to ship or otherwise deliver the donated item to the Foundation by October 15, 2026, unless other arrangements have been made with the Foundation in advance. Shipping address: PA Foundation for Home Care and Hospice, Attn: Michaelene Licht, 4075 Linglestown Rd PMB 239, Harrisburg, PA 17112.
The Pennsylvania Foundation for Home Care and Hospice is a 501(c)(3) charitable organization, contributions to which are tax deductible as permitted by law. The official registration and financial information of the Pennsylvania Foundation for Home Care and Hospice may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.
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Silent Auction Contributor Form

Contributor Information

Donation Details

Preferences

Acknowledgment