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Card Application Form
Proof of residency must be provided within 60 days of receiving a card notification.
Examples of proof of residency include drivers license, School ID (elementary, middle or high school) or utility bill.
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* Indicates required question
Check One
*
Under 14
Adult
65 or Older
Last Name
*
Your answer
Middle Initial
Your answer
First Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Phone
*
Your answer
Street Address
*
Your answer
Apartment Number
Your answer
City/State
*
Your answer
Zip Code
*
Your answer
E-mail
*
Your answer
Notify Me Via
*
E-mail
Phone
Text/SMS using the above phone number
If you chose Text/SMS above, please choose your provider below.
Choose
ATT
Republic Wireless
T-Mobile
Sprint
Verizon
Other
Parent/Guardian
Your answer
Would you like to receive periodic e-mails about Library news and events? *
Yes
No
Clear selection
I agree to take responsibility for all materials borrowed with this card. I agree to give immediate notice of any change of address and to report loss of card. A replacement fee will be charged for all lost cards. *
*
Yes
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