Vista Grande Public Library DONATION FORM

Is this your first donation to Vista Grande Public Library?  ___ Yes      ___ No

Donation Amount:______________ (Note: Adopt-a-Day is $83/day)

Your Information:

Name(s):_____________________________________________________________________

Address:_____________________________________________________________________

_____________________________________________________________________________

City:__________________________________  State:______________________________

Zip:__________________________    Phone Number:______________________________

E-mail:______________________________________________________________________

Would you like to subscribe to VGPL's e-Mail Newsletter?   ___ Yes     ___ No

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To designate your donation, please complete the following:

____Honorarium    ____Memorial   _____Adopt-a-Day

Name of Honoree: ____________________________________________________

Honorarium/Memorial/Adopt-a-Day text (e.g., in honor of Bill's 80th birthday):

____________________________________________________________________________

Date selected (Adopt-a-Day only):   MM_______  DD__________  YY_____________

Please mail acknowledgment card to:

Name(s):_____________________________________________________________________

Address:_____________________________________________________________________

City:__________________________________  State:_______________________________

Zip:__________________________    Phone Number:_______________________________

Please allow 8-10 working days for your acknowledgment card to reach its destination.

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If donating by Credit Card, please enter the following information as it appears on your credit card:

Credit Card:   ___Visa   ___MasterCard   ___Discover

Name:_______________________________________________________________________

Credit Card Number:______________________________  Card Expiration (MM/YY):________

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If paying by credit card you may fax this completed form to: (505) 466-3889; if paying by check or credit card, mail to:  

Vista Grande Public Library, 7 Avenida Vista Grande B7-#192, Santa Fe, NM 87508-9199

Please do not hesitate to call us if you have any questions:  (505) 466-7323

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