CONNELLSVILLE AREA JUNIOR HIGH LIBRARY
Book Donation Form
SCHOOL YEAR:
2015-2016
REQUESTER INFORMATION:
Name of Requester:
__________________________________________
Address:
__________________________________________
__________________________________________
Amount Donated:
__________________________________________
Type or Topic of Book, If Desired:
________________________________________________________________________
Note: Unless you prefer to choose a particular topic, we would be
happy to select a book needed in the library.
Date of Request:
__________________________________________
IN HONOR/MEMORY OF:
Name:
__________________________________________
Special Notes (To Be
Typed on Bookplate):
__________________________________________
PERSON TO WHOM CARD SHOULD BE SENT:
Name:
__________________________________________
Address:
__________________________________________
__________________________________________
LIBRARY USE:
Title of Book: _________________________________________________________
Author: _____________________________Call No.:_________________________
Amount: ____________________________Date Paid:_______________________
Date Payment Sent to Account:____________Check No.:_____________
Date Cards Sent ___________________
Date Bookplated __________________
Date Shelved ______________________