DUE DATE:††††††††††††††††††††††††††††††††††††††† Patron must be 18 years of age to borrow an e-book reader.

 

I am borrowing from the Bethel Public Library:††††††††††††††††††††††††††††††††††††† Replacement Cost

 

  1. One E-book Reader††† ††††††††††† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† $149.00
  2. Protective case††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† $† 25.00
  3. USB cable†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† $† 20.00†††††††††
  4. Power adapter†††††††††††††††††††††††††††††††††††† ††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† $† 25.00
  5. Instructional materials†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† $††† 5.00
  6. Tote bag††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† $† 10.00

TOTAL††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† $234.00

Patronís initials†††††††††††††††††††††††††††††††††††††††††††††††††††

 

I understand the following:

 

  1. I am responsible for returning the e-book reader within the 14 day loan period/or the one hour loan period.
  2. There is a $2.00-per-day fine up to a maximum of $234.00 if the item is returned late. Late fees accumulate from the first day the e-book reader is overdue.
  3. Replacement costs for lost or damaged items will be charged to the credit card listed below when the e-book reader is 7 days overdue.
  4. Bethel Library Reference staff will download one e-book of patronís choice from the OverDrive media catalog. Additional content that I download and/or purchase will be charged to my account.
  5. The e-book reader must be returned to the Adult Reference Desk with all equipment in the protective bag.†
  6. I will be charged $25.00 if the e-book reader is returned in the book drop or to another library.

 

Patronís initials†††††††††††††††††††††††††††††††††††††††††††††††††††

 

PLEASE DO NOT RETURN THE NOOK TO ANY OTHER LIBRARY.

PLEASE DO NOT RETURN THE NOOK IN THE BETHEL LIBRARY BOOK DROP.


For staff use only;† Patron signature required

 

PATRONíS NAME††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† PHONE NUMBER†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† †††††††††††††††

PATRONíS LIBRARY CARD #†††††† †††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

ID CONFIRMATION: CT DRIVERíS LICENSE†††††††††††††††††††††††† (Hold for in-house use) †††††††††††††††††††† PHOTO ID†††††††††††††††††††††††††††

 

CREDIT CARD:† MC†† VISA†† AMEX†† DISCOVER #††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† exp date†††††††††††††††

 

PATRONíS SIGNATURE††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Indicates receipt of agreement copy

 

DATE CHECKED OUT†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††††††† DATE RETURNED__________________________

 

STAFF INITIALS††††††††††††††††††††††††††††††† FILE COPY(original)††††††††††††††††††††††††† PATRON COPY†††††††††††††††††††††††††††††††††† ††††††††

 

 

Approved by the Library Board ††††††† April 25, 2011†††††††††††† ††††††††† ††††† ††††††††