Kirkwood Public Library
Secure Donation Form

Donation Summary:
Donation Type: *

Donation Amount: * $
Comments/Details:     

If you wish for someone to be notified of your donation, please include their name and address in the comments section above. If selecting "Buy a Shelf", please indicate how the name should appear on the shelf plaque and desired shelf category (e.g. fiction, biography, mystery, etc)

           
Credit Card Information:
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Name as on Card: *
Card Number: *
Card Expiration Date: * MMYY
Card ID (CVV2/CID) Number: * [What is the Card ID?]
   
Billing Information:
Company Name:   
First Name: *
Last Name: *
Address: *
Address 2:   
City: *
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Phone Number: *
Email Address: *
     
   

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