*1.Contact Information(Required.)

Name *

Library Name (also include institution name, if applicable) *

Address *

Address 2

City/Town *

State/Province *

AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming

ZIP/Postal Code *

Country

Email Address *

Phone Number *

*2.Secondary Contact Person(Required.)

Name

Email Address

Phone Number

*3.What is your library's current 4 digit delivery number?(Required.)

*4.What are your normal hours of operation, Monday through Friday?(Required.)

*5.Where is parking available for the courier at your library?(Required.)

*6.What are your current scheduled days/times for courier service?(Required.)

*7.Does the courier need a parking pass?(Required.)

Yes

No

8.If YES to Question 7, how does the courier obtain a pass?

*9.Is there a preferred entrance for the courier? Please provide as much detail as possible.(Required.)

*10.Does the courier need a key, keycard or access code to enter your location?(Required.)

Yes

No

11.If YES to Question 10, please detail the process for obtaining entry access.

*12.Where in the library does the courier make the delivery?(Required.)

*13.Please provide any other special instructions for the courier that will be picking up and dropping off materials to your location.(Required.)