Interlibrary Loan Form

Public Library of Mount Vernon and Knox County

Interlibrary Loan Form
Date:

MonthDayYear
Date
Staff Initials:
Patron Name:*
Patron Phone:*
Library Card #:*
Send to Branch?*

FredDanOutreachMV
Patron is aware that failing to pick up interlibrary loans will result in a $1 charge to his/her account.
Title or Subject:
Author or Performer:*
Format (check ALL acceptable forms):*

BookDVDLarge Print BookMusic CDSpoken CDOtherArticle
ILL Staff Only

Date:

SEO reserve placed _______ Entered in Polaris ________

OCLC request # _____________ OCLC locations ____________________
Submitting this form does not guarantee we will be able to get the requested item. We will contact you if there are any issues. You may only have 2 interlibrary loans out per library card
I understand
Should be Empty: