Homebound Delivery

Complete this form to apply for the Greenfield Public Library's Homebound Delivery Program.

Name*

Address*

Phone Number*

leave blank if you don't have an email address

Library Card Number*

Length of Time Delivery is Needed*

Long-Term Short-Term

Dates Needed

If Short-Term was selected above, please let us know the dates and/or length of time you will need the service.

Types of Materials

(8000 character limit. Characters so far: 0 Word Count: 0)

Please let us know which of these categories you would like to receive. Books -- Fiction, Books -- Large Print, Books -- Nonfiction, Books on CD, DVDs, Graphic Novels, Magazines

Favorite Authors/Books

(8000 character limit. Characters so far: 0 Word Count: 0)

List some favorite authors, books, or series to give us an idea of what you like.

Special Circumstances?

(8000 character limit. Characters so far: 0 Word Count: 0)

Let us know if there are any special needs or circumstances we should be aware of.

Your Wednesday Color*

Please review what you entered before you click the Submit button, and click it ONLY ONCE.