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2. Name of organization*
4. Business address*
6. City*
7. Zip*
9. Business phone*
10. email address*
12. Authorized representative*
    First, Middle, Last
14. Position at Organization*
16. Borrower 2
    First, Middle, Last
17. Borrower 3
    First, Middle, Last
19. Borrower 4
    First, Middle, Last
20. Borrower 5
    First, Middle, Last
22. PIN*
    4 to 10 digits using letters and/or numbers only, (no special characters or symbols).
23. 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.
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

* indicates a required field