Item Request Form Your contact informationFirst NameMiddle NameLast NameLibrary Card No: *0 / 15Select Library Pick Up Location *Pick Up LocationDeRidderFieldsMerryvilleSingerSouth BeauregardDate needed by: *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year20222021Email Address *Required to Issue a CardPhone Number - Day: *Phone Number - Evening/weekend:Street AddressApartment, suite, etcCityStateZIP CodeRequest InformationGeneral information about a subjectSelect OneLevel of Information:BasicIntermediateAdvancedProfessionalHow-toIf school relatedGradeNumber of sources required:SelectType of ProjectSocial StudiesScienceResearch PaperOtherSpecific Item RequestTitle:Author: (last, first)Copyright year:0 / 4Select OneHow did you find out about this title?Recently PublishedTVBook ClubBook PageInternetOtherMagazine or Periodical RequestPeriodical Title:Article Title:Article Author:Volume:Issue:Publication Date:Article Subject:Max Charge:Additional InformationIf you are requesting an item from another library, please read the following statement carefully: Materials borrowed from another library must be returned by the due date. Lending library must be reimbursed for any damaged or lost items. If a request has not been canceled prior to the date the library receives the material, a fee of $1.00 per item will be charged. Some libraries will only send photocopies of articles, not the entire magazine. Please be sure you have noted the maximum amount you are willing to pay in such a case, otherwise, we will have to assume it to be $0.00 and cancel the request.Process this requestPlease do not fill in this field.