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Home Delivery Service Application
Please note, you must live within Bridgeport city limits to receive home delivery.
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* Indicates required question
First and last name
*
Your answer
Please check if you are
*
unable to to physically travel to the library on your own because of long-term illness, impairment, medical condition, or disability.
experiencing temporary difficultly getting to the library due to recovery from an injury or surgery, winter weather conditions, caring for a new born, lack of transportation or other circumstances.
Required
What is your address?
(
Please note, you must live within Bridgeport city limits to receive home delivery.
)
*
Your answer
Do you have a Bridgeport library card?
*
Yes, I do.
No, I need to register for one.
What is your Bridgeport library card number?
Your answer
What is your phone number?
*
Your answer
Please list someone as your additional point of contact. We will only contact them if we are unable to contact you.
(Please include their first and last name, phone number, and their relationship to you.)
*
Your answer
Are there any additional materials that you are interested in checking out?
DVDs
Music CDs
Puzzles
Books on CD
Magazines
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you are acknowledging that you understand our terms and agree to them.
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Yes
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