Request a Library on Wheels Stop – Form Request a Library on Wheels Stop * indicates a required field1 Contact Information2 Facility3 Site Information4 Customer Information5 Publicity6 Driving Directions Name * Required First Last Address Street Address Address Line 2 City ZIP / Postal Code Phone * RequiredCellEmail * Required Next Facility Information (if applicable) Site Manager's Name Facility Name Facility Address (if applicable) Street Address Address Line 2 City ZIP / Postal Code PhoneCellEmail Building Security/Emergency Contact First Last Phone Previous Next Site of Requested Stop * RequiredLocation of Stop * RequiredIs site off the road? * RequiredYesNoIs site level? * RequiredYesNoIs site paved? * RequiredYesNoWould entrance door (passenger side) be away from traffic? * RequiredYesNoDoes the site accommodate parking of a 25-foot vehicle? * RequiredYesNoIs there clear access for Bookmobile parking? * RequiredYesNoWill space be reserved for Bookmobile parking? * RequiredYesNoWill sidewalks be cleared of ice, snow, leaves, etc.? * RequiredYesNoAre restroom facilities available for library staff?YesNoIs there access to a 110 or 220 electrical outlet?YesNoIs WiFi available on site?YesNoIs the nearest library more than 5 miles away?YesNoAlternate Parking Location Previous Next How many residents are in vicinity/in residence?What is the age range of potential customers?Are the residents sufficiently mobile to get into the bookmobile (3 steps)?YesNoWould residents need wheelchair access?YesNoWhat time do the children return from school?YesNoDo potential customers need foreign language materials?YesNoIf so, which languages?Recommended TimeWhat time of the day would we see the most people? HH : MM AM/PM AM PM Would building/facility staff be available during stop?YesNo Previous Next Do you have a resident newsletter?YesNoIf yes, will you include Bookmobile information in it?YesNoAre we able to post signs advertising the stop?YesNoDoes the facility have a web page?YesNoIf so, would you provide a link to the library's web page?YesNoOther PublicityWhat other ways may we publicize the stop? Previous Next Driving Directions from I-5Any other pertinent information you can provide to help us serve you better:NameThis field is for validation purposes and should be left unchanged. Previous Close Can you tell me more about this webform submission? The contents of this webform are sent to library staff via email. We recommend that you do not submit confidential information (like your library card number, passwords or credit card information). If you need to share confidential information with library staff, we suggest that you use other channels of communication, such as the telephone.Visit our Privacy Statement, opens in a new window to learn more about how your personal information is handled and protected. This information will be submitted via email. Learn More about sending data over email. This iframe contains the logic required to handle Ajax powered Gravity Forms.