Adult Library Card Application

1. Library borrower and circulation records are confidential and exempt from Freedom of Information requests. All information requested below is intended to help the library serve you better. You must bring ID and proof of Norwalk residency with you when picking up your card. at the Main Library, 1 Belden Ave.

   Library borrower and circulation records are confidential and exempt from Freedom of Information requests. All information requested below is intended to help the library serve you better. You must bring ID and proof of Norwalk residency with you when picking up your card. at the Main Library, 1 Belden Ave.

2. Complete list of
   Acceptable Forms of ID

4. First Name*

5. Last Name*

6. Street Number*

7. Street Name*

8. Apt #

9. City*

10. State*

11. Zip*

12. Home Phone Number*

13. Cell Phone

14. Email*

15. 2nd Address (place of employment or other)

16. Street Number

17. Street Name

18. Apt #

19. City

20. State

21. Zip

22. Phone

23. Date of Birth*

    mm/dd/yyyyy

24. Sex*
    -- Select One --FemaleMale

25. Social Security Number

    Optional

26. Driver's License Number*

27. State/Country*

28. Exp. Date*

29. Agreement Terms:
    I am responsible for all materials borrowed on this library card and will pay all late charges and fees for damaged and lost materials. I will notify the library if my card is stolen, or if I change my address.

    I am responsible for all materials borrowed on this library card and will pay all late charges and fees for damaged and lost materials. I will notify the library if my card is stolen, or if I change my address.

30. I Agree with these terms:*
    1. I Agree

Leave This Blank:


31. 1. Receive email copy
32. Email address

33. Submit

* indicates a required field