Donation Form

We gladly accept your donation!

Please provide the following information and email to ncfragilex@gmail.com by September 15, 2008.

Contact ncfragileX@gmail.com with your questions or comments


YES, we will donate an auction item to the Carolina Benefit Auction.

Company (or Name):_____________________( as you wish it to be printed in the Auction Booklet)
Address____________________________________
Contact Person_______________Title______________
Phone _______________ FAX________________
Email___________ Website _______________
Value: $______________

Description: __________________________________________________________________
_____________________________________________________________________________________________
______________________________________________________________________________
Restrictions:________________________________________________________________________________

___Certificate Enclosed ___Pick Up Item ___Item will be Delivered
___Please prepare a certificate based on information provided

Thank you for your support!

The National Fragile X Foundation is a 501(c)(3) tax exempt organization. Our Federal ID # is 84-0960471. Your donation is tax deductible under the fullest extent of the law. Consult your tax consultant for further information.