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Purchase or Interlibrary Loan Request Form

Today's Date
Today's Date
Is the item you're requesting a:*
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This form does not guarantee the library will purchase or interlibrary loan your request. All requests are reviewed by the library's InterLibrary Loan librarian. If your item is purchased, holds will be placed in the order received. To request a copy of an article, please stop in the library or call us at 319-753-1647. If your request is borrowed from another library, you will have 7 days (after you are notified) to pick up your item. Your account will be charged $3 for each item requested but not picked up. Please fill out your contact information in order to complete your request.
This form does not guarantee the library will purchase or interlibrary loan your request. All requests are reviewed by the library's InterLibrary Loan librarian. If your item is purchased, holds will be placed in the order received. To request a copy of an article, please stop in the library or call us at 319-753-1647. If your request is borrowed from another library, you will have 7 days (after you are notified) to pick up your item. Your account will be charged $3 for each item requested but not picked up. Please fill out your contact information in order to complete your request.
Title*
Author/Actor/Director*
For DVD requests please fill in the actor / director boxes.
Actor
Director
Please complete the following information:
First Name*
Last Name*
Burlington Library Card Number*
Address1*
Address2
City*
State*
Zip*
Phone Number*
Email Address*
If you do not wish to receive an email (or do not have an email address) please type "NA."

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1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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