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Home-bound Delivery Application

Use this form to register for Home-Bound delivery of items from Liberty Lake Municipal Library. You will be contacted by the Library to set up an account and delivery schedule.

At this time, only those living within the 99019 and 99016 zip code areas are eligible for once a month home delivery.

Questions marked with a (*) are required

1. Your first and last name: *
2. Your street address: *
3. Your zip code *
4. Your phone number: *
5. Your email address if you have one:
6. I am unable to leave home without assistance or significant effort for three months or more *
True
False
7. The best time to reach me by phone is:
8. If a friend or relative is filling out this form for you, that person's name is:
9. The phone number of the person who is filling out this form, if not the applicant:

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