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2. Please complete the following form if interested in purchasing a bench in a City of Bothell park. Upon submittal of your form, Park Operations staff will contact you for further coordination and approval prior to taking payment.

4. First Name*
5. Last Name*
7. Preferred Bench Location*

   NOTE: Final site and location will be decided by City of Bothell Park Operations staff in coordination with the Donor. Bench may only be installed on City of Bothell property and some sites may be unavailable for bench placement. Please refer to the Park Donations page for additional information about which locations are available. 

9. Requested Inscription on Plaque*

   NOTE: Plaque language shall be text only (no signs, symbols, or logos) and be approved by the City. Text is limited to the name of the donor and/or person being honored, date, and no more than 10 words description or explanation. The words “In memory of” or birth and death dates are not permitted. The words “In honor of” may be used. Please check spelling and punctuation. Recommended wording for a plaque is: 

   Donated by the friends and family of

   [Name]

   [Year]

11. Phone Number*
12. Email Address*
14. Billing Address*
16. Billing Address 2
18. City*
19. State*
20. Zipcode*
22. Agreement*

    1. I have read and understand the bench and plaque donation guidelines outlined on the Park Donations page.
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field