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2. First Name*
3. Last Name*
5. Library Card Number*
6. Phone Number*
8. Email Address
9. Today's Date*
   Today's Date
11. Address1*
13. Address2
15. City*
16. State*
17. Zip*
19. Requested Material Not Needed After (Date):*
    Requested Material Not Needed After (Date):
21. Potential Mailing/Copying Costs*

    The Interlibrary Loan Department will first try to obtain the materials from free suppliers, who are members of a local courier system. If the materials need to be mailed and/or shipped to us, the borrower WILL be responsible for the return fee. Some libraries may charge a loan or photocopy fee. To help us process your request, please tell us if you are willing to pay mailing and copying costs, if any, for the material.

    1. Yes
    2. No
23. Member Initials:*
24. This request is for (select one):*
    -- Select One --BookAudiobook on CDDVDMagazine ArticleMusic CDSubject Information
26. Title (do not use abbreviations, one form per request):
27. Author:
29. If you need a certain edition, please tell us the date published and the publisher:
31. Date Published:
32. Publisher:
34. IMPORTANT: For material classified as non-circulating (archival/genealogy/local history/microform/reference) list the specific information (e.g., ancestor names, portions of an index, table of contents, obituary, etc.) you would like PHOTOCOPIED below:
36. Article Title (needed for photocopying purposes):
38. Volume:
39. Number:
41. Date
42. Pages:
44. NOTICE: WARNING CONCERNING COPYRIGHT RESTRICTION. The Copyright Law of the U.S. (Title 17, U.S. Code) governs the making of photocopies or other reproductions of copyrighted material. Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specified conditions is that the photocopy or reproduction is not to be “used for any purpose other than private study, scholarship or research.” If a user makes a request for, or later uses, a photocopied reproduction for purposes in excess of “fair use,” that user may be liable for copyright infringement. This institution reserves the right to refuse to accept a copying order, if, in its judgment, fulfillment of that order would involve violation of the U.S. Copyright Law.
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