You can either provide documentation of residency within 30 days at the Library, or attach it to this form (see westhamptonlibrary.net/library-cards for acceptable documentation).

First Name *required

Last Name *required

Email *required

Primary phone *required

Secondary phone

Date of Birth *required

Local Full Physical Address *required

(without this we cannot issue a card - this address must be in the Westhampton Beach Union Free School District or in one of our contract districts)
Number & Street:

Westhampton BeachWesthamptonQuiogueEast MorichesEast QuogueEastportManorvilleRemsenburgSpeonk
State:

New York

Zip:

Full Mailing Address (if different from physical)

Street/PO Box: Town: State:
New YorkAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip:

If renting, lease expiration date

Proof of residency (PDFs or JPGs only, maximum size 20 MB):

Comments/Questions

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