Home library direct service

This form will take approximately 10 minutes to complete.

Page 1 of 1.

Title * Select or enter your title.

Other Enter your title if not listed above.

First name * Enter your first name.

Last name * Enter your last name.

House name/number * Enter the address name or number. This could a flat, house or building name or number.

Address line 1 * Enter the first line of the address. This could be the street name.

Address line 2 Enter the second line of the address if you need to. This could be the village name.

Town/city * Enter the town or city of the postal address.

Postcode * Enter the postcode, with or without spaces.

Email address Enter an email address where we can write to you.

Phone number * Enter a daytime phone number that we can ring you on. This can be a mobile or land line number.

Alternative phone number Enter another phone number we can reach you on. This can be a mobile or land line number.

Local library Select your nearest library.

Likes Enter the types of books you like.

Dislikes Enter the types of books you don't like.

Can you tell us why you need this service? Enter why you need this service.

Would you like large print books? Select 'Yes' or 'No' as your answer.

Yes
No

Would you like audiobooks? Select 'Yes' or 'No' as your answer.

Yes
No

Please provide details of someone we may contact if we are unable to reach you.

Title (alternative contact) * Select or enter their title.

Other (alternative contact) Enter their title if not listed above.

First name (alternative contact) * Enter their first name.

Last name (alternative contact) * Enter their last name.

House name/number * Enter the address name or number. This could a flat, house or building name or number.

Address line 1 * Enter the first line of the address. This could be the street name.

Address line 2 Enter the second line of the address if you need to. This could be the village name.

Town/city * Enter the town or city of the postal address.

Postcode * Enter the postcode, with or without spaces.

Phone number * Enter a daytime phone number that we can ring them on. This can be a mobile or land line number.

I am unable to reach or use my nearest library due to age, caring responsibilities, illness or disability. * Tick to confirm