Contribution Form

Please print out and fill in the form below in order to help us utilize your contribution in the way that most interests you.

Please make checks payable to:
The Library Foundation

Please mail your donation to:
Corvallis-Benton County Public Library Foundation
645 NW Monroe Ave
Corvallis OR  97330

Name _____________________________________________________

Address ___________________________________________________

City, State, and Zip ___________________________________________

Phone Number ____________________

E-mail ___________________________

__$1000  __$500    __$200    __$100    __$50    __ $25    Other $_____

Please mark the selection(s) that you would like to see your donation used for:

___ to supplement the annual book and materials budget

___ to invest in the future through the endowment

___ to meet special library needs

___ other

___ (optional) This gift is ___ in honor or ___ in memory of:

Name ______________________________________________

Please notify _____________________________ of this gift.

Address _______________________________________

City, State, and Zip _______________________________

___ I prefer to receive acknowledgement/tax receipt via e-mail

___ I would like to receive the “Check It Out” newsletter via e-mail