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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
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