Home Delivery Service Application Online application for home delivery service Please fill out the form below and we will contact you shortly. Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Email Library Card #Name of secondary ContactPhone # of Secondary ContactI am a resident of the Hicksville School District who is unable to use the facilities because (check all that apply):I am a resident of the Hicksville School District who is unable to use the facilities because (check all that apply): I have a physical disability I am confined to home due to illness Extended convalescence Advanced Age I do not have a household member to pick up library materials I am experiencing a short-term loss of mobility associated with surgery/illness and request this service for a finite period of time. Favorite Authors and TitlesFavorite Genres Romance Mystery Historical Fiction Sci Fi / Fantasy Westerns Non-Fiction Other Preferred Formats Regular Print Large Print Paperback DVD/Blu Ray Playaway E-Book CD Audio Books ConsentI give permission to the Hicksville Public Library to keep a record of the library materials sent to me in order to avoid duplication. This information is confidential. Enter any additional info here:
