Potential Acquisition Questionnaire

1. The item(s) is a: (check all that apply)

2. Describe the item(s). If object or work of art, include information such as size, material, color, markings, manufacturer/creator. If book or publication, include title, author, number of pages, publisher, date, edition. Also describe physical condition, including missing and/or replacement parts.

3. Is the item(s) a donation?       Yes       No

4. Contact information:

Name:

Address:

Telephone (day and evening):

E-mail address:

5. Additional comments: