Belgrade Community Library

Empowering a community of lifelong learners

 

106 N BROADWAY

BELGRADE, MT 59714

(406)388-4346

www.belgradelibrary.org

 

REQUEST FOR MATERIALS MAILING SERVICES

 

 

Name ______________________________   Library Card Number _____________________

 

Address _____________________________ Phone Number __________________________

 

                ______________________________                Email address ___________________________

 

Description of Condition __________________________________________________________   ______________________________________________________________________________                                ________________________________________________________________________                _______________________________________________________________________                  

This condition is        Permanent           Temporary

 

If temporary, how long do you expect to require materials mailing services _____________________                                                                                                                                

 

During the indicated time, I attest that I will have significant difficulty accessing the Library in person.

 

I request return postage be provided to me for the duration of utilizing Material Mailing Services.

         Yes            No

 

Date _____________________________________                                                                                  

 

Signature__________________________________                                                                                                 

Staff Initials for Confirmation _____________________________                                                      

 

This form expires on _____________________________(6 months from start date), unless renewed by the patron and the Library.

 

The Materials Mailing Service is based upon grant funding.  If there are insufficient funds or if the Library elects to terminate the Materials Mailing Service, you will be notified via the preferred method indicated in your library account.