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 Video/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:
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
As an option, we can purchase an item from one of the following Divisions:
Arts Humanities Science Social Science Professional Graduate
Or you may choose one of the following departments - Note: if no subject or division is specified, an item of general interest will be purchased:
General Art Black Studies Business Chemistry Communication Deaf Studies Education English Equine Science Foreign Languages History/Political Science Life Sciences Math/Computer Science Music Nursing Physics Psychology Religion/Philosophy Sociology Theatre Women's Studies
Payment Method:
Print out a completed version of this form and mail it along with your check, made payable to Otterbein College, to:
Lois F. Szudy Library Director Courtright Memorial Library Otterbein College 1 Otterbein College Westerville, OH 43081
Comments:
If you have a comment or would like to provide additional information, please indicate below:
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