Welcome to Laurens County Library

Card Application

  

Name ________________________________________________________________

(please print)  Last                                            First                               Middle

 Birthdate (for identification purposes only) ______________________________________

                                                                            month/day/year

For notification of arrived holds and overdue items:

Email address (optional)___________________________________________________

 PIN number which allows you access to your account from home (optional)

 # ­___   ___   ___   ___

 Mailing address________________________________________________________________

 Street address (if different from above)______________________________________________

 City, State, Zip code ____________________________________________________________

 Phone  (____)________________________ Phone 2 (optional) (____)_____________________

         

If Applicant is under 14 years old   As the parent or legal guardian of the child named on this application I authorize the issuance of a Library Card to the child. I assume responsibility for material borrowed on this card including fines incurred, loss of items or damages to items.   Signature_____________________________________________________   Please print name signed__________________________________________
=============================== For office use only    Photo ID with current address    Photo ID and mail    Other ____________________	Received by______  Date_______________   Verified by _______ Date_______________

 

 

 

 

pk  7/20/2009