Book Donation Form
2005-2006
Please Note:
It is possible to donate up to 2 books by submitting the form once. If you would like to donate more than 2 books, please re-submit the form.
As a convenience to the donors, we accept MasterCard and Visa.
Bookplates will be created exactly as worded. There is a limit of 120 characters.
Parent/Donor Name:
Evening Phone:
Day Phone:
Email:
Book Title:
Book Author:
Child's Name and Grade (if applicable):
Price
For a bookplate, please complete the dedication field (120 characters max):
Check
here if dedication is to a Potomac teacher or staff member:
Check here
if acknowledgement letter for 3rd party is needed.
If so, please provide address:
To donate a second book, please complete the following :
Book Title:
Book Author:
Child's Name and Grade (if applicable):
Price
For a bookplate, please complete the dedication field (120 characters max):
Check
here if dedication is to a Potomac teacher or staff member:
Check here
if acknowledgement letter for 3rd party is needed.
If so, please provide address:
I would like to donate the following cash amount for library needs:
Total Amount:
Card:
Select
Visa
Mastercard
Expires:
Select
1
2
3
4
5
6
7
8
9
10
11
12
Select
2005
2006
2007
2008
2009
2010
Credit Card Number:
Name on Card:
