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Materials Request Form

2. 

4. Materials Request
   Please use this form to make a purchase request to add an item to our collection, or if you would like us to order an item from another library.

   Please use this form to make a purchase request to add an item to our collection, or if you would like us to order an item from another library.

5. Type of Request*
   -- Select One --Adult or Teen PurchaseYouth PurchaseInterlibrary Loan Request

   Please select the option that best fits your request.

6. Today's Date*

8. First Name*

9. Last Name*

11. Library Card Number*

    Please enter your 7-digit Library card number here.

12. Your email

13. Phone Number *

    Please enter your number, including area code.

15. Material Format*
    -- Select One --BookCDDVDAudio CassetteVideo CassettePeriodical ArticleMicroform

    Please select one item per form.

17. Author

    List Author(s) (if applicable)

18. Title*

20. Publication Date

21. Volume, Number, Pages (If article)

22. Interlibrary Loan Ok?
    -- Select One --YesNo

    If we are unable to purchase an item, would you like us to order it from another library?

24. Agreement
    NOTE: Your initials are REQUIRED if you're making a Interlibrary Loan (ILL) request. "I understand that I will be responsible for all return postage if not picked up. Lost or damaged materials will be charged to my account. I agree to return all materials on time. I realize that not all requests may be filled."

    NOTE: Your initials are REQUIRED if you're making a Interlibrary Loan (ILL) request. "I understand that I will be responsible for all return postage if not picked up. Lost or damaged materials will be charged to my account. I agree to return all materials on time. I realize that not all requests may be filled."

26. Additional fees (ILL Requests Only)

    1. 0
    2. up to $5
    3. up to $10
    4. up to $15
    5. up to $20
    6. $21 +

    Please indicate how much you're willing to pay if a lending library charges a fee. This does not include postage.

27. Your initials (REQUIRED FOR INTERLIBRARY LOANS)

    Please enter your initials to indicate you agree with the above conditions.

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field