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2. Non-Resident Library Card Application

   Please note: A fee does apply for non-residents outside of Beaumont city limits.

4. Legal Name*
6. Date of Birth*
   Date of Birth
7. Sex (M/F)*
9. Residence Address*
11. City*
12. State*
13. Zip Code*
15. Mailing Address*
17. City*
18. State*
19. Zip Code*
21. Phone Number*
22. Alternate Phone Number
24. Email*
28. Which Library location would you like to pick your Library Card up from?*
    -- Select One --R.C. Miller LibraryTheodore Johns LibraryElmo Willard LibraryDowntown Main Library
32. I understand that*

    1) I am responsible for all items borrowed with this library card, including late, lost, or damaged materials.

    2) I will notify the library immediately if the card is lost or stolen.

    3) I will notify the library of a change of address and/or telephone number. (By City Ordinance, it is unlawful for a non-resident to use the card unless Beaumont city property taxes are paid or an annual non-resident fee is paid.)

    4) I understand that the card is city property and I must return it upon request.

    1. I understand all
34. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
36. Electronic Signature*
38. Employer Name and Address*
40. Photo of Applicant's Driver's License*

    Please upload a scan or photo of your valid Driver's License with your name, face, and address clearly visible. 

Leave This Blank:


42. Submit

* indicates a required field