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Organization Card Application
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Name of organization
*
Business address
*
City
*
Zip
*
Business phone
*
email address
*
Authorized representative
*
First, Middle, Last
Position at Organization
*
Borrower 2
First, Middle, Last
Borrower 3
First, Middle, Last
Borrower 4
First, Middle, Last
Borrower 5
First, Middle, Last
PIN
*
4 to 10 digits using letters and/or numbers only, (no special characters or symbols).
Submission Statement
By submitting this form electronically you are stating that you are an authorized representative for your organization, you are requesting an Anoka County Library Organization card by email, and you agree to be responsible for any material borrowed on this card.
Leave This Blank:
Receive an email copy of this form.
Email address
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