Required fields are marked with asterisks (*)

Homebound Delivery Application

Please complete the application form if you or someone you know would benefit from home delivery of library materials.

First Name

Last Name

Mailing Address

Phone Number

Email Address

Alternate Contact Name

Relationship to Applicant

Alternate Contact Phone

Do you have an Orangeville Public Library card?

Yes

Reason Home Delivery is needed

I prefer my delivery in the ...

Morning

Afternoon

Anytime

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