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2. First Name*
3. Last Name*
5. Phone Number*
7. Email Address
9. Enter your library card number (14 digits)*

   This form is for renewing Madison Heights library cards only.

11. Do you need to update your address?*

    1. Yes
    2. No
13. Address
14. Zip Code
16. Do you need to update your phone number?*

    1. Yes
    2. No
18. Phone Number
19. (If Mobile Phone) Who is the Cell Phone Carrier?
21. Do you need to update your email address?*

    1. Yes
    2. No
23. Email Address
25. Photo ID Front*

    Please attach image of Driver's License or State ID both front and back. If your ID does not show a Madison Heights address, please include Proof of Residency as well.

26. Photo ID Back*

    Please attach image of Driver's License or State ID both front and back. If your ID does not show a Madison Heights address, please include Proof of Residency as well.

28. Proof of Residency

    If your ID does not  show a Madison Heights address, please provide: mortgage or rent receipt, utility bill, or voter's registration card showing your name and Madison Heights address. If needed a staff member will contact you.

30. Notification Preference*
    -- Select One --EmailPhone CallText Message

    Select one.
32. A new library card style is available:

    1. Yes! Please send me a Baby Yoda library card and new number.
    2. No thanks, I want to keep my same card.

    

34. A library staff member will contact you once your card has been renewed.

    If we receive your request outside of regular business hours, you will hear from us on the next business day.

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field