Change of Service Form

*Change in service
Choose Temporary/Vacation Hold Stop Service Deceased

Patron ID (if known)

*Full Name

"In care of" (if applicable)

*Address (Street or P.O. Box with Apartment/Room number)

*City

*State
Please Choose Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

*ZIP

*Telephone, with Area Code

Email address

*Name of person submitting request and relationship to library user (if applicable)

For temporary holds, please provide a start date

If you like your service to automatically resume, please provide an end date