Interlibrary Loan Form

Author:

Title:

Format:

Book
Audiotape
Videotape

Large Print Book
Microfilm
Compact Disc

Publisher:

Date of Publication:

Date Needed By

Library Card Number:

*Your Name:

Address:

Address 2:

City/Zip:

Daytime Phone:

*E-mail address:

Pickup Location: Main Branch Jefferson City Osage Branch - Linn

Would you be willing to pay a possible fee from lending library:

Yes No

If dollar amount applies, the average cost is $10.00.