CLD&J Home Delivery Service Application Form

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Thank you for your interest in the home delivery service for eligible residents living in the Library’s
Jamesville-DeWitt service area. Please complete the entire form. A library staff member will get in touch via phone within four business days of the submitted application.

If you have any questions about how to complete the form or the Home Delivery Service, please contact the Coordinator for Community Engagement and Outreach at sbrandt@cldandj.org.

Applicant's Name: *

Address: *

Telephone: *

Emergency Contact Name: *

Emergency Contact Telephone Number: *

Do you currently have a library card from one of the libraries in the Onondaga County Public Library system? *

Yes

If yes, what is your library card number?

May we keep a record of the items you check out to assist us with future selection and prevent duplication? *

Yes

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