Media by Mail Online Form Application for Homebound patrons to receive Media by Mail. Name(Required) First Last Library card number(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) Are you able to receive a large package in the mail?(Required) Yes No How would you like to request library items?(Required) I would like a librarian to select items for me. I would like to place my own requests through the catalog. What type of materials would you like?(Required) Books Audiobooks DVDs Select AllIf you would like to receive DVDs, what movie ratings do you like? G PG PG-13 R Not rated Select AllWhat kind of books do you like? Fiction Non-fiction Graphic Novels Large Print Select AllWhat is your preferred reading level? Birth - PreK K - 3 Grade 3 - 6 Grade 6 - 10 Grade Young adult Adult Select AllPick your favorite genres! Adventure Romance Fantasy Science Fiction Mystery Thriller Western Inspirational Bestsellers Horror Health/Fitness Spy Drama Occult Religion Family Amish Cooking Crafts Science Art History Biography True Crime Classics Current Events Historical Fiction Sports Politics Humor Animals Suspense Plays/Poetry Select AllDo you have any favorite authors or other comments?Permissions for library staff to access account history(Required) I give VBDL permission to access my account history. I don't give VBDL permission to access my account history. If you would like the library staff to select items for you, we want to do our best to not send you the same titles multiple times (unless you request that item). To do this, we would need to access your library account to change a setting so we can see what has previously been checked out to you during your use of this service.The Michigan Library Privacy Act prohibits the library from sharing information about your account with anyone other than you, not even your spouse or family. If you would like the library to be able to share information with others, please indicate so here.(Required) No, only share information about my account with me. Yes, the library may share my information with the person(s) listed below. If applicable, please enter the names of persons who have permission to receive information about your account.By checking the box below, you agree to assume all responsibility for damage or replacement of library materials under loan to you, as well as any fees assessed for materials returned after their due date. You will give immediate notice to the library of changes to address or telephone number.(Required) Agree
