Card Registration Form:

I apply for the right to use the Antioch Public Library District and promise to comply with all its rules, to pay promptly damages charged to me, and to give immediate notice of change in my address.

Business Name: (required)

Business Address: (required)

City: (required)

State: (required)

Zip: (required)

Business Phone Number: (required)

Business Owner Full Name: (required)

Home Address:(required)

Home Phone: (required)

Email Address: (required)

SMS Text Number:

Cell Phone Carrier:

Would you like your borrowing history to be saved? (required)
YesNo

Employees able to use this card: (can list up to 4)
1.

2.

3.

4.