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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

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Name

Address

City State Zip

Phone (day) (evening)

Email

Date of birth (optional)

I prefer this gift to remain annonymous.

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. Mail to: Development Office, Providence Public Library, 150 Empire Street, Providence, RI 02903.