Please print out this form and complete it, or
Hand write a note that gives us the same information:
First Name:________________________________________________
Last Name: _______________________________________________
Your address:______________________________________________
City, State: ________________________________________________
ZIP/Postal Code:____________________________________________
e-mail address:______________________________________________
Telephone:_________________________________________________
This donation is in honor of:
First Name:_________________________________________________
Last Name:_________________________________________________
Organization:_______________________________________________
Other:_____________________________________________________
I wish to remain anonymous (circle if appropriate).
Make your check out to: "Friends of the Belmont Library"
in memo line, write: "New Library Fund", for ______________________
Mail check and information via U. S. mail to:
FOBL
Box 826
Belmont, CA 94002
attn: donation
Thank You.