LIBRARY CARD APPLICATION AND RENEWAL FORM
Attn: Circulation Department

First Name: _____________________________________________

Last Name: _____________________________________________

Home Address: __________________________________________
    (P.O. Box not acceptable)

City: ______________________________________

Zip Code: __________________________________

Home Phone: _______________________________

E-Mail: ____________________________________

I am a new patron. This is my FIRST library card.
My card is expired. I need to RENEW it.
I LOST my card. I need a new one. ($1.00 replacement fee)

Barcode: _______________________________  (Only necessary for lost cards and renewals.)

Date of Birth : ___________________________  (Required for age 14 and under.)

You will need to prove residency by providing a copy of one of the following documents:

• Driver's license
• Utility, phone or tax bill

Choose one of the following options to apply for a card or renew your current library card:

• Option 1.
  Print this application form, attach a copy of a proof of residency document (from list above), and mail to:
  
      South Huntington Public Library
      145 Pidgeon Hill Road
      Huntington Station, NY 11746
      Attn: Circulation Department
  
  
• Option 2.
  Fax completed application along with a copy of a proof of residency document (from list above) to the Library' Circulation Department at: 631.549.0246