INTERLIBRARY LOAN REQUEST

 

Location To Be Picked Up____________________________________

 

Name:______________________________________________ Date:_______________________

 

Library Card No.:________________________________________________        

 

Home Address:______________________________________________ Home Telephone_______________________

 

                                                                                                                                        ______________________________________________

 

Business Address:___________________________________________ Business Telephone____________________

 

                                                                                                                                        ______________________________________________

 

Author________________________________________________________________________________________

 

Title__________________________________________________________________________________________

 

______________________________________________________________________________________________

 

Periodical/Newspaper_____________________________________________________________________________

 

______________________________________________________________________________________________

 

Source of Reference_______________________________________________________________________________

 

Last Date Needed___________________________ Maximum willing to pay___________________________________

 

¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨      ¨

 

In accordance with the National Interlibrary Loan Code, I agree to abide by the rules of the lending library and to return materials on or before due date.

 

 

SIGNATURE OF BORROWER:______________________________________________________________________

______________________________________________________________________________________________

________________________________________________________________________________________________