900 E. McKinley St. Harvard, IL 60033 Phone: 815-943-4671 Fax: 815-943-2312

Homebound Delivery Application

Name (Please Print):

______LAST FIRST MI

Address: ______Harvard, IL 60033 (Homebound Delivery service is not currently available to Nonresident cardholders outside of city limits)

Home Phone: (______)-______-______Cell Phone: (______)-______-______

Email: ______

Please provide us with a contact name and phone number Name: ______if you cannot be reached for an extended period of time: Phone: (______)-______-______

Special Delivery Instructions:

Please check any or none of the following:

I do not wish to receive books that: I prefer: □ Contain strong language □ Books in Large Print □ Contain excessive violence □ Books in Large Print Only □ Contain explicit sexuality □ Books on CD □ ______□ Books on CD Only

Please list your favorite books and authors below:

Preferred number of items per delivery:

Books (Limit 8) ______DVDs (Limit 5) ______Please check any areas of interest below:

□ Arts □ Crochet □ Knitting □ Painting □ Cookbooks □ Film/Television Books □ Music Books □ Crafts □ Photography □ Art History □ Quilting

□ Bestsellers □ Biographies/Memoirs □ Actors/Actresses □ Musicians □ Comedians □ Public Figures & Politicians □ Business & Economics □ Classic Literature

□ Religious/Inspirational □ Christian Romance □ Historical Christian Fiction □ Christian Mystery/Suspense □ Religious Nonfiction (Please Speficy): ______

□ Fantasy □ Epic Fantasy □ Historical Fantasy □ Urban Fantasy □ Fairy Tales □ Heroic Fantasy

□ Fiction □ African-American Fiction □ Multicultural Fiction □ LGBTQ Fiction □ Urban Fiction □ Women’s Fiction □ Contemporary Fiction □ Humor □ Literary Fiction □ Graphic Novels (Comics)

□ Historical Fiction □ Medieval Fiction □ Victorian Fiction □ U.S. Historical Fiction □ World Historical Fiction □ Other Specified Era: ______

□ Historical Nonfiction □ U.S. History □ World History

□ Horror □ Ghosts/Demons □ Psychological Horror □ Witches □ Vampires □ Zombies

□ Mysteries □ Classic Detective □ Cozy Mysteries □ Historical Mysteries □ Police Procedural □ True Crime

□ Nature Nonfiction □ Poetry □ Politics/Global Affairs □ Psychology/Self-Help

□ Romance □ Contemporary Romance □ Historical Romance □ Romantic Suspense □ Erotic Romance

□ Science Nonfiction □ Environmental Topics □ Computers/Technology □ Astronomy □ Chemistry □ Agriculture □ Biology/Medical Science

□ Science Fiction □ Dystopian □ Hard Sci-Fi □ Space Operas □ Steampunk □ Time Travel

□ Sports Nonfiction □ Preferred Sports Topic(s): ______

□ Thrillers/Suspense □ Legal/Political Thrillers □ Military Thrillers □ Psychological Thrillers

□ Westerns □ Classic Outlaws □ Western Romance

Other Genre or Author Preferences:

Are there any book series you are working on, or have already completed? Please list below (will help prevent sending books you have already read).

If you are interested in DVD deliveries, please indicate preferences below (only fill out if you intend on receiving regular DVD deliveries):

Television:

□ Sitcoms □ Documentaries □ Drama □ Reality TV □ Action □ Fantasy □ Horror □ Detective/Crime □ Sci-Fi □ Other (Please Specify):______

I enjoy: □ American TV □ British TV □ Australian TV

My favorite TV shows are:

Movies:

□ Action □ Drama □ Fantasy □ Romance □ Sci-Fi □ Musicals □ Comedy □ Animated □ Horror □ Thrillers □ Western □ War □ Family-Friendly □ Based on True Stories □ New Releases

Movie ratings I’m okay with: □ G □ PG □ PG-13 □ R

My favorite movies are: