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2. Please confirm that all information on this form is valid. It is possible that your request may be denied if no other libraries are willing to lend the item.
4. Name on Library Card
5. Library Card Number
7. Phone Number
8. Email Address
10. Address1
12. City
13. State
14. Zip
16. List the title and author of the item you would like to request. If you are requesting a book in large print, an audiobook, or a DVD, list the type of item under "Format."
18. Title of Item
20. Author (If Known)
22. Format
    Example: Large print, audiobook, DVD
23. ISBN (If Known)
25. If you do not have a specific title in mind and would like a book on a certain subject area, list that here:
Leave This Blank:


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

    This field is not part of the form submission.

29. Submit

* indicates a required field