Homebound Delivery Request Form

Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Email
example@example.com
Library Card Number *
Loan History Opt In
By signing this form I am opting in to save my loan history. I acknowledge that the Redford Township District Library will retain data about titles that I have borrowed using my library card. Loan history information will be available for display within My Account and will only include titles that are checked out after I opt-in. Titles that I borrowed prior to opting in will not be available for display. Loan History data will be retained for 5 years. Michigan law prohibits library staff from disclosing information contained in library records, except as outlined in the Michigan Library Privacy Act.
Initial here
Please select your preferred material (Check all that apply)

Large Print Regular Print Audiobooks Music CD DVD
Reading Interests (Check all that apply)
Fiction:

General Mystery Western Classics Historical Fantasy Science Fiction Thriller Family Sagas Short Stories Romance Inspirational
Favorite Authors:
Non Fiction:

Biographies Business/Economics History Computer/Technology Health/Medical Travel/Adventure Psychology/Self Help Government/Politics Homemaking/Cookbooks Gardening/Nature Humor/Entertainment Folklore/Fairy Tales Sports/Recreation Philosophy/Religion Arts and Crafts
Specific Topics or Titles:
How many items would you like to receive per month? (Up to 6)
Delivery instructions: *
Should be Empty:

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Loan History Opt In

Reading Interests (Check all that apply)