WILLIAMSON PUBLIC LIBRARY

	WILLIAMSON PUBLIC LIBRARY
	LIBRARY CARD APPLICATION

FULL LEGAL NAME	_______________________/	_______________________/	______________
	Last Name	First Name	Middle

ADDRESS____________________________________________________________

CITY___________________STATE______ZIP___________COUNTY___________

PHONE (______)_______-___________

E-MAIL_______________________________________________

DRIVERS LICENSE #________ BIRTHDATE __ __ / __ __ / __ __

I accept full responsibility for all use made of my library card and will immediately report loss, theft or unauthorized use of my library card to the library. I understand that the library will pursue all legal means available to reclaim unreturned materials.

PATRON’S SIGNATURE_____________________________DATE________________

(Or parent’s signature if applicant is under 12 years of age)

PARENT’S NAME (print)__________________________Parents Card # 2/__________


FOR STAFF USE ONLY User Profile________________________ PIN #___________________ Location Issued_________________ Staff Initials____________ Patron Barcode # 2/___________