5 books for $15.00

10 books for $30.00

20 books for $60.00

other amount (greater or smaller), please specify $

Donor's Name:
Donor's Address:
City:	State: ALAKAZARASCACOCTDEDCFLGAHIIDILINIAKSKY LAMEMDMAMIMNMSMOMT NYNENVNHNJNMNCNDOH OKORPARISCSDTNTXUT VTVAWAWVWIWY Zip:

How do you want your donation listed in our official records?

Donated by self, as listed above

Donated in honor of

This is a gift, please send gift card to:

Name:
Address:
City:	State: ALAKAZARASCACOCTDEDCFLGAHIIDILINIAKSKY LAMEMDMAMIMNMSMOMT NYNENVNHNJNMNCNDOH OKORPARISCSDTNTXUT VTVAWAWVWIWY Zip:

Further acknowledgement of your donation may be made as follows (check all that apply):

Your name or honoree’s name on books donated

Public acknowledgment in local media

Fill out and print this form. Make check payable to Olean Public Library. Mail or deliver to:
Reach Out and Read, Olean Public Library, 134 N. 2nd St., Olean, NY 14760.
Acknowledgement for tax purposes will be sent to donor.