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2. You will receive your card within 10 business days. If there is a problem with your application, a Circulation Services staff member will notify you as soon as possible.
4. I am at least 13 years of age, a resident of Moline, and*

   1. applying for my first Moline Public Library card.
   2. renewing my expired Moline Public Library card.
   3. replacing my lost or stolen Moline Public Library card ($3 replacement fee due upon activation of card).
6. Last Name (as printed on ID)*
7. First Name (as printed on ID)*
8. Middle Initial
10. Preferred First Name (optional)
12. Residence (Street Address)*
14. PO Box (if applicable)
16. City*
    Non-Moline residents are ineligible to apply.
17. Birthdate*
    Birthdate
    Applicant must be at least 13 years old. For parents or guardians applying on behalf of their child, please use Library Card Application - Under Age 13.
19. Email Address*
20. Telephone Number (with Area Code)*
22. How would you like receive notices for available holds or overdue items?*

    1. Phone
    2. Email (includes courtesy reminder notices 3 days before items are due)
24. I will obey all rules and regulations of the Library, pay fines for any lost or damaged items borrowed on my card, and give immediate notice of change of address. *

    1. I agree.
26. By providing my email address, I agree that I will receive occasional email communication from the Moline Public Library. *

    You may unsubscribe any time from the footer of any e-mail. The library will never share, distribute, or sell your e-mail address.

    1. I agree.
28. To activate this card, I will present valid photo ID and proof of residency at the Moline Public Library. *

    1. I agree.
30. PLEASE READ
    Moline Public Library Circulation Policy

    Includes more information on children & privacy, lost & damged items.
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field