Name(s) ______________________________________________________________________

Address ______________________________________________________________________

City ___________________________________________ State _________ Zip ________________

Telephone ( ) ____________________________ Fax ( ) ____________________________

Email ______________________________________________________________________________

Yes! I support the Provincetown Public Library Building Project Capital Campaign Fund.

q $ 50,000 CHECKS -- My check for $ _____________ is enclosed,

q $ 25,000 made payable to the * “PPL Building Fund”.

q $ 10,000

q $ 5,000 ** CHARGES

q $ 2,500 Please charge my VISA or MasterCard as follows:

q $ 1,000 Account # __________________________________________

q $ 500 Expiration Date _____________________________________

q $ 250 Signature ___________________________________________

q $ 100

q $ 50 ** You may also provide support for the PPL Building Fund

Other $ __________ through monthly donations with a minimum of $15 per month

by selecting that option below:

PLEDGES “I authorize PPL to charge $ _______________

I pledge a total of $ ____________ to my credit card each month”.

I am enclosing $ _______________ Signature ______________________________________

I will pay the pledge

balance by _________ (date).

*** I am making my/our gift in honor/memory of

Name(s) _______________________________________________________________

Address _______________________________________________________________

City _______________________________ State _____________ Zip __________

Signature _____________________________________________ Date _________________

** Your contribution to the Town of Provincetown’s “PPL Building Project Gift & Grant Fund”

is tax-deductible to the maximum extent allowed by law.

*** When you make a gift to the “Library Building Project Gift & Grant Fund” in someone’s name,

both you and s/he become donors and a gift card is sent.