2024 Non-Resident Reimbursement Request

2024 Non-Resident Reimbursement Request

For use by South Ramsay residents currently patrons of Carleton Place Public Library
Name*

First NameLast Name
Full Address*

Street or Concession Number

Street Address Line 2

MunicipalityProvince

Postal Code
-

Rural Route

Street Address Line 2

CityProvince

Postal Code
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Required for reimbursement:
A dated receipt from Carleton Place Public Library for your non-resident fee for membership paid. An image of the receipt can be uploaded with this form, or emailed (a photo of the receipt is fine) to: almontelib@missmillslibrary.com or mail your receipt to: 155 High Street, Almonte ON K0A 1A0
Receipt Image Upload

Cancelof
If you need financial assistance to prepay your Carleton Place Library non-resident membership, the Mississippi Mills Public Library may be able to help you. Please call Christine at 613-256-1037 or email crow@mmpubliclibrary.ca
Reimbursement Terms and Conditions:
The reimbursement is $45 per household for library membership fees paid to Carleton Place Public Library. Residents must reside in South Ramsay(map here) and be current (or recent) members of the Carleton Place Public Library and use the Carleton Place Public Library as their main library.
Household $45
Payment Type Requested

Please mail me a cheque.I will come in person to Almonte Branch Library to pick up (please wait to be notified that your cheque is ready).
Notice of Collection of Personal Information:
Personal information collected on this form will be used to verify residency and process the reimbursement. It will also be used for statistical purposes to determine the number of households accessing library services in Carleton Place.
I hereby certify that the information I have provided in this reimbursement request is true and accurate to the best of my knowledge. I agree to the terms and conditions and other information provided above and consent to the use of this request application for the purposes specified.
Name*
Date*

MonthDayYear
Date
Are you a current member of the Mississippi Mills Public Library?*

YesNo
www.missmillslibrary.com – almontelib@missmillslibrary.com – pakenhamlib@missmillslibrary.com
Should be Empty: