Organization Name

501c(3) Tax ID

Event

Date Of Event

Contact First Name

Contact Last Name

Address

City

State

Zip

Phone

E-mail

What Will The Item Be Used For (silent auction, door prize, etc.)?

What Will The Proceeds Be Used For (please include age group benefiting)?

What Item Are You Requesting?

All Fields are Required For Successful Submission

I acknowledge the items and proceeds donated by Xavier Athletics will be used for the purposes identified and will not benefit high school, preparatory school or junior college students or programs. Submitting a request does not guarantee a donation by Xavier Athletics. An e-mail confirmation will be sent when the request has been received. Please allow 4-6 weeks for your item to be received.