Library Valet Service

• Pick Up Date * (You will be contacted by the library when your materials are ready.)
  {MM/DD/YYYY}
• First Name *
• Last Name *
• Library Card *
• Email *
  {example@example.com}
• Phone Number *
  - Area Code Phone Number {428-2189}
• Material Requests: Authors, or Titles (Please specify format ex Large print, Audio Book, DVD, Blu-Ray, Video Game, Etc. for each item)
  
  
• Secondary Material Requests: (If we don't have your initial requests, what else could we get you?)
• Notification Preferences. *
  Notify me by email Notify me by phone call
• Can we sign you up for our email newsletter?
  Yes, Please
• I certify that the above information is correct. I accept financial responsibility for all materials borrowed from this application. *
  I Accept
• Please enter the text from the image below *
  
Submit