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Printable Support Form

Enclosed is a gift of
(NOTE: gifts of $1,000 or more are recognized with membership in the Conservator Society of Providence Public Library)

Check enclosed.

OR . . .

Please charge my account
Name on the account

MC/VISA

AMEX#

Exp. date

Signature

My gift will be made through the United Way.

My company will match this gift. My matching gift form is enclosed.

Annual pledge of $ to be paid in installments
First payment to be sent on this date


Name

Address

City State Zip

Phone (day) (evening)

Email

Date of birth (optional)

I prefer this gift to remain annonymous.


Please print this form and mail to Foundation Office, Providence Public Library, 150 Empire Street, Providence, RI 02903.

For questions or information about your gift or the Conservator Society, please call Nancy Ponte, Development Manager at (401) 455-8003 or at nponte@provlib.org.