Use this form to sign up for our Home Delivery Service Borrower Information First Name Last Name Address Address Address 2 City/Town State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Date of Birth Phone Number Email Address Contact Person (if requesting on behalf) First Name Last Name Do you have a Conneaut Public Library card? Yes No Library Card Number Where should materials be picked up and dropped off? (porch, mailbox etc.) Library Preferences Don’t select materials for me. I want to pick specific titles. Please choose books for me based on my preferences as listed below. Fiction Genre Preferences Mystery Romance Horror Thrillers Suspense Drama Historical Western Fantasy Sci-Fi Graphic Novels Other… Enter other… Non-Fiction Preferences Biography U.S. History World History Politics Business Science Poetry Travel Art Films Health Animals Sports Religion Technology Other… Enter other… Preferred Formats Large Print Regular Print Audiobooks DVDs Blu-Rays List some of your favorite authors or series Do you give the Conneaut Public Library consent to keep track of your checkout history? (this ensures you will not receive duplicate materials.) Yes No Submit Book traversal links for Home Delivery Registration ‹ Home Delivery Up Notary ›
