Donor Information
Name: ______________________________________________
(As it will appear in donor publications)
Address: _____________________________________________________________________________
City: ___________________________________________ State: ________ Zip: __________________
Phone: _______________________________ E-mail: _______________________________________

Donation
I would like to buy ___ book(s) at $25.00 each Total donation: ___________
My gift of $_______________ is enclosed (Please make your check payable to the HCPL Foundation)
Or
Please bill my MasterCard/Visa # _______________________________ Exp. Date _______________
(circle one)
Name on Card ______________________________ Signature __________________________

Matching Gift ___ My company will match my gift. The matching gift form is enclosed.

If this gift is a memorial or tribute, please complete the following:
In memory of: __________________________________________________________________
In honor of: __________________________________________________________________

Individual or family to be notified of your gift (gift amount will not be disclosed)
Name: _____________________________________________________________________
Address: _____________________________________________________________________________
City: ___________________________________________ State: ________ Zip: _________________

Other Information
___ I would like to discuss sponsorships and other special giving opportunities. Please call me.
___ I would like my gift to remain anonymous.

Please print and return to: Harford County Public Library Foundation
1221-A Brass Mill Road
Belcamp, MD 21017

The Harford County Public Library Foundation is a 501(c)3 non-profit organization and all gifts are fully tax deductible to the extent allowed by law. Information under the Maryland Charitable Organizations can be obtained from the Secretary of State at 410-974-5534.