House Calls Application | Pickens County Library System

Name*

First

Last

Phone

Address*

Street Address City State Zip Code

Email

Emergency Contact

First

Last

Emergency Contact's Phone Number

Who do you want to deliver to you?

Library Volunteer

Friend or Relative

Phone

If you want a friend or relative please list their name.

First

Last

Do you have a Pickens County Library card?

Yes

No

If so what is the barcode number?

How many items would you like to receive each month?

Who are your favorite authors?

Other Details:

Other:

Date

Initials:

Additional Notes: