Interlibrary Loan Request

For use by Carroll Community College faculty, staff and students.

(Click in each field or use the Tab key to move from field to field.)

Library Card #:
*Street Address:
*Zip/Postal code:
*Work Phone:
*Home Phone:
Affiliation with Carroll Community College:
*Deadline: (This date must be supplied)
Default date is one month.

If we must request information from an institution that charges us, we have to pass on the charges. 
Are you willing to pay a charge up to $10.00?  Yes      No

*Title of Periodical or Book:

*Authors(s) of periodical article or book:

*Copyright date: Edition:

*Title of Article:
Volume: Issue #: Date: Pages:

*How did you find out about this material?
Please supply the source of reference (include volume, pages, etc.)

Completion of this form signifies compliance with the guidelines of the current copyright laws.

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