Name
First Name
Last Name
E-mail
example@example.com
Phone Number
-
Area Code
Phone Number
Name of Organization
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Description of Request
*
Method of Delivery (Please select one.)
*
Please Select
Send records to me electronically if available.
Segregate records for me to review in person. The Custodian will notify me when records are ready for review.
Make copies for pickup by requestor. The requestor will be invoiced and must pay for the copies before the copies are released.
Make copies and mail to requestor. The requestor will be invoiced for duplication fees as well as postage, and must pay before the copies are released.
Submit
Should be Empty: