Library Card Application

Library Card Application

Fill out the form with as much information as possible. Please leave contact information in case we have follow-up questions.
Name*

First NameMiddle NameLast Name
Birthdate*

MonthDayYear
Date
Is the applicant under 18 years of age?

YesNo
DLN or State Issued ID*
Name of Parent or Guardian*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Township
County
Phone Number

Area CodePhone Number
Email address*

Confirmation Email
Notes or other info:
Please allow 24 hours for us to process your request. You will receive an email from askus@plainfieldlibrary.net with your card number and PIN. You may then use this number to access our databases, apps, and to log in to your Evergreen account to place items on hold.

By submitting this form, you agree to the following:

By signing, I accept the responsibility for all materials borrowed on the library card/my
child's card issued through this application with the understanding that the library may
include materials that I personally deem inappropriate. I agree to abide by the library's
policies and to pay all fines and fees for overdue, lost, stolen, or damaged materials
borrowed using my card/my child's card. I agree to notify the library immediately if my
card/my child's card is lost or stolen, or when any of the information I have given
changes.
Should be Empty: