Name (First and Last):
Telephone: Home Work
Distance to Post Office:
Do you want books:
REQUEST ONLY? Check yes here is you want to receive library materials ONLY when you ask for a specific title, author, or subject. If you want REQUEST ONLY service, stop here and send us a list of requests. If you send a long list, we will send book shipments regularly until all requests are filled.
Check yes here if you want to receive library materials automatically every 6-7 weeks. We will send your requests in addition to the titles we chose based on your profile. (Complete your profile below.)
We can send up to 20 books and 4 audiobooks (books on CD), movies (DVDs) and music (CDs) for a total of not more than 25 items. How many of each of these items would you like in each shipment? Please enter a quantity and then select the types of movies or music you prefer.
Adults in household (Names):
What percent of fiction (novels) or non-fiction (factual books) would you like?
Place the individual adult's number next to the type of books he/she would like to receive.
Children in household (Names and year of birth):
Place the individual child's number next to the type of books he/she would like to receive.
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