New Memorial/Honor Book Donation Form

Memorial / Honor Donation Form

If you would like to make a book donation in honor or memory of a loved one, please fill out this form. Please use this form only if you are placing a donation to be paid with Square, our payment vendor. For cash or check payments, please contact the library directly 812-663-2826.

Date of Donation:

MonthDayYear

This request is a:*

Donation in Memory / Honor of: *

First NameLast Name

Information about Donor.

Click here if you do not want a card sent to your address for this donation.

No card needed

Donor Name

First NameLast Name

Donor Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Donor Phone

Area CodePhone Number

Donor Email Address:

Information about family to be notified.

Click here if you do not want a card sent to the family.

No card needed

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

More family members? Add more names and addresses in this box:

Information about the Donation

If you do not wish to use Square for your donation, please contact the library directly to make your donation.

Suggested Donation Amounts:

Hardback Book: $25
Children's Picture Book: $20
Audiobook: $35
DVD: $20
Music CD: $15
Local History Material: $25
Programming / Special Projects: Any

Topic or Subject of Interest:

Please list the type of item you would like added to the collection (eg. Hardback Book, Music CD, etc.):

Payment*

USDDonation Amount

Credit Card

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