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Tool Lending Library Borrower Form
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* Indicates required question
Name (Full Name)
*
Your answer
Address
*
Please include number, city, zip
Your answer
Main Phone Number
*
Your answer
Email Address
*
Your answer
Date of Birth (Must Be 18 or Older)
*
MM
/
DD
/
YYYY
Tool(s) Requested
*
Your answer
Project Description
*
Your answer
Do You Own Your Home
*
Yes
No
Unknown
Landlords Name and Contact Info
*
Note: If you do not own your home, your Landlord will be asked to approve your Tool Borrower request.
Your answer
What Is Your Household Size
*
1
2
3
4
5
6
Column 7
1
1
2
3
4
5
6
Column 7
1
What Is Your Household Income
*
$0 - $25,000
$25,000 - $50,000
$50,000 - $75,000
$75,000 - $100,000
$100,000 - More
Demographic Information (Gender)
*
Female
Male
Other:
Required
Please Specify Your Ethnicity
*
Caucasian
African-American
Latino or Hispanic
Asian
Native American
Native Hawaiian or Pacific Islander
Required
Please Select Your Sub-Neighborhood
*
Ashby Row
Brikyaat
Cegielnia Crossing
Coldbrook Creek
North of Market
Old East End
The Woods
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