Purim Ball 2010 Absentee Auction Bid Form

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

* Email Address

Fill in up to three item names and the exact amount you want to bid for each item*. Please enter the HIGHEST BID you are willing to make for the item. That bid will be entered on your behalf before the silent auction begins. If you are the high bidder for an item your credit card will be charged and you will be notified.

	BID FOR A CHANCE TO WIN!
Item Name
Max. Bid Amount
Item Name
Max. Bid Amount
Item Name
Max. Bid Amount

Contribute to the Susan Koss Scholarship Fund. Please enter the amount of your donation below. Thank you for supporting JPDS-NC!

Please fill out your credit card information below. If you are the winning bidder for an item, your credit card will be processed the night of the Purim Ball.

* Name on Card

* Credit Card Type

* Credit Card Number

* Expiration Date (mm/yy)

*All absentee bids must be submitted by 11:59 p.m. on Saturday, March 13, 2010. Partially completed forms will not be accepted.

* Indicates Response Required