Book & Media Request

First & Last Name *

LCMail Email *

LC State Affiliation *

Student

Faculty/Staff

Book or Media Title *

Author / Artist *

Copyright Year *

ISBN

Please select the amount you would pay to receive this item *

No, I will not pay fees to receive this material

I will pay $1 - $5

I will pay $6 - $10

I will pay $11-15

I understand that overdue interlibrary loan items accrue fines at a rate of $3/day, per item. *

If you are an Outreach student, please provide your address so interlibrary loan items can be mailed to you

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