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Homebound Delivery Service Application

  1. Contact Information
  2. Do you currently have a Madison Heights Public Library card?*
  3. If you already have a Madison Heights Public Library card, enter the full number here (no spaces).

  4. Alternate Contact Information

    Please enter the contact information for an alternate person if the library is unable to contact you regarding your existing services. Providing this information will grant us permission to share information about your account with the person listed.

  5. Patron Preferences
  6. Please enter a number between 1 and 100.

  7. Preferred formats:

    Select all that apply.

  8. Reading Interests

    Please select all that apply.

  9. Fiction
  10. Non-fiction
  11. Please specify any of the above reading interests. 

    Example: Travel, Europe; History, French Revolution

  12. Please list your favorite authors and/or titles of books you have especially enjoyed.

  13. Leave This Blank:

  14. This field is not part of the form submission.