Purchase or Interlibrary Loan Request Form

2. Today's Date
   Today's Date

4. Is the item you're requesting a:*
   -- Select One --BookBook on CDBook on CassetteLarge Type BookMusic CDDVD (Not available through interlibrary loan.)MagazineVideo cassetteBlu-ray (Not available through interlibrary loan)eBookArticle

   Choose One

6. This form does not guarantee the library will interlibrary loan your request. All requests are reviewed by the library's InterLibrary Loan librarian. If your item is purchased, all holds will be placed in the order received. Thank you for your suggestion.

   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.

   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.

8. Title*

9. Author/Actor/Director*

11. For DVD requests please fill in the actor / director boxes.

13. Actor

14. Director

16. Please complete the following information:

18. First Name*

19. Last Name*

21. Burlington Library Card Number*

23. Address1*

25. Address2

27. City*

28. State*

29. Zip*

31. Phone Number*

32. Email Address*

    If you do not wish to receive an email (or do not have an email address) please type "NA."

Leave This Blank:


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

    This field is not part of the form submission.

35. Submit

* indicates a required field