Piedmont Regional Library System

Interlibrary Loan Request Form

Today's Date:	Not needed after:

Patron Name:

Library Card #:	E-mail/Telephone:

At which library location would you prefer to pick up this item?:

☐Is the item found in WorldCat (http://worldcat.org)? If found, attach copy of the record.

Fill out the following to request a book

Title:

Author:

Publisher and date (if known):

Do you need a particular edition of this title?:

Fill out the following to request an article

Name of magazine, newspaper, etc:

Volume:	Issue:	Date:

Title & Author of the Article:

Paging of the Article:

ISSN of magazine, newspaper, etc (if known):

Fill out the following to make a microfilm request

Title:

Author:

Reel # (if known): Year :

Additional information:

Note: Loan periods for interlibrary loan materials are set by the lender. Renewals are usually not possible.

2.23.21