Library Account Application

Mott Public Library

Residents living within the City of Mott, ND are eligible to receive a free library Account. We accept donations in the amount of $25 per year for patrons who reside outside the service area.

Last Name: _____________________First Name:_________________ M.I. __

Birth date ________  

Your parent has the option to opt out of this Library Agreement if you are under 18 years of age. A copy of this application will be sent to the address listed below.

Mailing Address:  _________________________  City:____________  

State: ________                  Zip Code:_______

Home Telephone Number: ________________ Email Address:______________________

Name of School, Business or State Agency: ______________

Work/School Address:   ___________________________

Work/School City: _______________ Work/School State:_____  Work/School Zip Code: _______

Work or School Telephone Number:_________

• I apply for borrowing privileges with the Mott Public Library, I agree to OBSERVE the Library’s rules, take proper care of the materials lent to me, RETURN them when due, and PAY promptly for any materials lost or damaged while in my possession. I understand that no other person may borrow on my card. I understand, also, that my privileges will be cancelled if I fail to abide by this agreement.
  Signature:________________________

• I Opt my minor child Out of a Library Account. Opt out must be received within 10 days of application.  Date mailed: _______     Signature:________________

Return to:
Mott Public Library
202 E. 3rd St
Mott, ND 58646

Mott Public Library

202 E. 3rd St / P.O. 57

Mott, ND 58646

mottndlibrary@gmail.com

701-824-2163

Dear Parents,

     Your child has signed up for a Mott Public Library Account. Please review the application for accurate information. Please complete information and return to the Library. There is the opportunity for parents to opt their children out of a Library card if they so choose.

Thank you.

Carol Kunnerup, Library Director

Mott Public Library