Deposit Service Facility Card Application – Form Deposit Service Facility Card Application To apply for a Deposit Service Facility library card, please complete this application. Name of Business Name of Representative First Last Position Held Business Address Street Address Address Line 2 City ZIP / Postal Code Business Email Business PhoneMailing Address Street Address Address Line 2 City ZIP / Postal Code Facility Director's Name First Last Facility Director's PhoneFacility Director's Email ConsentThe facility accepts financial responsibility for all materials charged on this card and agrees to pay any fines assessed by the library for lost or damaged materials. In the event of outstanding lost materials, library staff can discuss with facility staff the alternative options available for continued library service. I understand this card is to be used for the informational and recreational reading needs of the residents in my facility. I understand that it is my responsibility to notify the library if I leave the facility or will no longer be the facility’s representative. I hereby declare the information given on this application to be true and correct.NameThis field is for validation purposes and should be left unchanged.
