LIMIT 2 ITEMS, DUE IN 2 WEEKS

LÍMITE DE 2 ARTÍCULOS, POR 2 SEMANAS

Name/Nombre

First Name *

Last Name *

Email/Correo electrónico

Phone Number/ Número de Teléfono

Address/Dirrecion

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

Please list the title and library book numbers of the items you would like to check out. There is a limit of 2 items, which are due back in two weeks.

Please choose how you would like to receive your books. Some options are to pick it up from outside the Family SOUP office or have them delivered to your home by a Family SOUP employee. We will use your phone or email to confirm.

5470pf7tt4e1

Signature

I accept full responsibility for the prompt return (within 2 weeks) of all library materials borrowed, so that others may also benefit from these resources. I agree to pay the necessary replacement costs for damaged, lost, or un-returned materials.

Date

Month

Day

Year

DDS Logo

Library

LIBRARY CHECK-OUT FORM