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Interlibrary Loans Book Request

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TODAY'S DATE
AUTHOR (Last name first; give more than initials if possible.)
TITLE
PLACE, PUBLISHER, DATE (edition)
Other edition acceptable?

Yes
No

YOUR ORIGINAL SOURCE OF INFORMATION (i.e. Book--Title and Call Number, OPALL Computer, Bibliography, Student)
CANNOT USE MATERIAL AFTER THIS DATE
YOUR NAME
PROGRAM OF STUDY
BOX NUMBER
PHONE/EXTENSION