Tipitina’s Foundation Auction Donation Form

Monday, April 28th, 2008 5PM till @ 501 Napoleon Avenue, New Orleans

PLEASE PRINT:

Business/Donor Name:

Address:

City/State/Zip:

Phone:

Fax:

E-Mail Address:

Type of donation:

Description including title:

Short artist bio if applies:

Signature of Donor:

Date:

Value/ (Amount if Cash Donation) $

Would you prefer to stay anonymous?

Would you like your website listed on ours?

www.

How will your donation be sent?

Ship or mail your donation to:

ATTN: IAC
The Tipitina’s Foundation
4040 Tulane Ave., Ste. 8000 New Orleans, LA 70119

*Please include this completed form with your donation to insure tax receipt.
For questions contact: foundation@tipitinas.com or 866-372-0512

Many thanks for your support and your wonderful donation!