Make checks/money orders payable to: Crockett Public Library.

Mail to:

          Crockett Public Library

          P.O. Box 1226

          Crockett, TX 75835

Signed by: _________________________(representative’s name)

Organization name___________________________________________

Address_______________________________________________________

Telephone_____________________________________________________

Meeting room? Auditorium____ Board Room___ Other____

Equipment needed? Cords, plug strips etc. __________________

_________________________________________________________

Meeting Date(s)____________________________(Month, Day, Year)

For Office Use Only:

Employee’s Name:

Date:

Method of Payment:

Meeting held as scheduled? yes___no___

Was the room returned to its original condition? Yes___no___

Any problems?_________________________________________________