If you already have a Springfield Library card, print out and fill in the section below and write in the barcode number of your library card in the section that starts "I already have a Springfield Library card."
If you do not have a Springfield Library card now, print out and complete this application and make a photocopy of a current picture ID with your current name and current address. Fax, mail or have your caregiver bring the application and the photocopy to the circulation desk of any Springfield Library. We will mail you your library card.
The mailing address is: Borrowers Services, Springfield Library, 220 State Street, Springfield, MA 01103. The fax number is 413-263-6817.
_________________________________ _____________________________ ______
Last Name First Name M.I.
______________________________________ _________
Street Address Apt. No.
_________________________________ ________ __________
City State Zip
Telephone (include area code): ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___
___ ___ ___ - ___ ___ - ___ ___ ___ ___ __________
Social Security Number Year of Birth
I already have a Springfield Library card. Its barcode number is:
D 74 ___ ___ ___ ___ ___ ___ ___
I authorize/designate the following person(s) to use my library card to borrow
materials for me until ___________ indefinitely ________________.
Each of the persons I name below knows they will be required to produce a photo
ID each time they use my card.
Name_______________________________________________
Address __________________________________________
Name ____________________________________________
Address _____________________________________________
STAFF USE ONLY:
Barcode Number Assigned: D 74 ___ ___ ___ ___ ___ ___ ___
Patron Type Assigned (circle) HOMEBOUND (4) HANDICAPPED (101)
Expiration Date ______________________
Date ____________ Site ___________ Staff member's initials _________
Results: ____ Card mailed. Follow-up letter sent.
____ Card not mailed. Follow-up letter sent.
___ Has existing current card # ______________.
___ Has outstanding fines
Message on patron's record "Designated Borrower(s) Name & Name. Must show ID."
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