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.

 PATRONíS SIGNATURE_____________________________DATE________________

(Or parentís signature if applicant is under 12 years of age)

 PARENTíS NAME (print)__________________________Parents Card # 2/__________

FOR STAFF USE ONLY

 User Profile________________________ PIN #___________________

Location Issued_________________    Staff Initials____________

 Patron Barcode # 2/___________