Name
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First Name
Last Name
Library Barcode Number
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Phone Number
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Phone Number
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Area Code
Phone Number
Email
example@example.com
Material Type
*
Book
DVD
CD
Book on CD
Title
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Author / Artist / Actor
*
Date of Publication (optional)
ISBN (optional)
Will you accept a $3 charge if the item must be retrieved from out of state?
*
Yes
No
I have a deadline for this item:
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Month
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Day
Year
Date
Additional Comments
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