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2. Note

   The sign in or create account option above refers to your city account, not your library account. 

4. Donor Name
6. Address
8. City State Zip
10. Phone
12. Email
14. Date
18. Message

    Inscribed with 3 lines of text, max. 15 characters per line (including spaces).

20. Line 1:
22. Line 2:
24. Line 3:
26. Note

    Please be patient with us while waiting for your brick to be placed. We order and install the bricks two times per year, usually in the spring and fall. We will notify you as to the date and time of installation once it is scheduled.

30. Payment Type

    1. Check - Payable to Anacortes Public Library Foundation
    2. Credit Card/PayPal
32. Please Mail or Deliver Checks To

    Anacortes Public Library Foundation

    1220 10th St. 

    Anacortes, WA 98221

34. 
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field