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Interested in donating an item to Epilepsy of Arizona's Epilep-TEA event? Please complete the form below. EFAZ reserves the right to package your item.

Donate An Auction Item

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

Terms & Conditions:*

I would like to remain anonymous:*

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No

Please select a pick up/drop off method:*

Comments & Special Instructions:

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

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At least one phone number is required.*

Mobile Phone:

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Email:*