INTERLIBRARY LOAN REQUEST FORM

(UPDATED 2011)

 

Library requesting loan: ____________________________†††††††† Date: ____________

Patronís name: ______________________________Phone #: ____________________

 

Patrons Library Card #: ______________________

 

Type of material being requested: (book, periodical, etc.)_______________________

 

Title____________________________________________________________________

 

Author: __________________________________ Subject: ______________________

 

ISBN: ____________________________

 

 

 

Staff member making request: _____________________

 

Additional information if necessary/available: ________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

(RESERVED FOR LOCAL LIBRARY OFFICE USE ONLY)

 

LCC #: ___________________________ †† Date requested: ______________________

 

ILL #: ____________________________††† Lending library: _____________________

 

Date received: ________________†† Date due back to lending library: _____________

 

Date returned to lending library: _______________

 

 

 

Comments: ________________________________________________________________________________________________________________________________________________________________________________________________________________________