Adult Library Application

Title

First

Middle

Last

Suffix

Degree

Date of Birth

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

County

County in which you reside in

Telephone

4 Digit Pin#:

4 Digit Pin#

Email address

Email Address

How would you prefer your notices?

Printed/Mailed

Texted

Emailed

I agree to the terms of service.

I accept responsibility for all materials charged to this card with or without my consent. I assume responsibility for all charges incurred by the use of this card. I understand that library fees and collection fees are set by the Cleveland City Council and are subject to change. To minimize liability, I will inform the library immediately of a change of address, email address or if the card becomes lost or stolen. Privileges will be suspended if: mail or email is returned, fines, or fee remain on account over 30 days (regardless of amount), or fines or fees over $5.00. Please see Internet Use Policy.

Internet Use

Yes

I DO want internet access

I do NOT want internet access

ID#

Valid Government Issued ID:

ID Expiration Date:

Date ID expires

Signature

Sign above

Date

Todays Date