Homebound Services Form

Request for Materials Mailing Services

  1. This condition is:
  2. During the indicated time, I attest that I will have significant difficulty accessing the Library in person.

  3. I request return postage be provided to me for the duration of utilizing Material Mailing Services.
  4. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  5. (6 months from start date), unless renewed by the patron and the Library.

  6. The Materials Mailing Service is based upon grant funding.  If there are insufficient funds or if the Library elects to terminate the Materials Mailing Service, you will be notified via the preferred method indicated in your library account.

  7. Leave This Blank:

  8. This field is not part of the form submission.