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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:


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

    This field is not part of the form submission.

31. Submit

* indicates a required field