Fund a "Book" Form

Please provide the following information:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
FAX
E-mail

Choose the type of material you would like for us to purchase:

Book
DVD
Music CD
Computer Software/CD-ROM
Periodical Subscription (Must agree to more than one year commitment)
Other -- Please specify:

Choose one of the following options:

Item in Memory of Someone
Item Honoring Someone
Item Honoring a Special Occasion or Anniversary

Name of person or occasion as it is to appear on bookplate:

Amount of donation:

$250.00
$100.00
$50.00
$25.00 (minimum donation)
Other: Please specify

Payment Method:

Print out a completed version of this form and mail it along with your check, made payable to Otterbein University, to:

Lois F. Szudy
Library Director
Courtright Memorial Library
Otterbein University
1 S. Grove St.
Westerville, OH 43081

Comments:

If you have a comment or would like to provide additional information, please indicate below: