Homebound Delivery Application
Fields in bold are required. If you have any questions about this application, please call (765) 641-2456.
I understand that I assume full financial responsibility for the materials I receive. If any materials are lost or damaged, I agree to pay the library the cost of replacing them. (By entering your initials in the box below, you indicate your agreement with this statement.)
Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.
A: B: Click to Move
Tuesday, December 10, 2013
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Have questions about an event?
Contact - firstname.lastname@example.org