ILL Request: Book

Name: Jimmy Lo
Price range: $

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First Name

Last Name

Library Card Number

Address

Phone

Statement of Responsibility

By checking the box below you agree to comply with the following statements:

I am responsible for all books I borrow through Interlibrary Loan (ILL) and will pay the borrowing fee plus any fines and/or fees for late, damaged or lost materials.
I understand that I must pay the ILL fee even if I fail to pick up the item.
I understand that the overdue fine for an ILL book is $1.00 per day.
I understand that the lending library sets due dates and renewal dates, as well as costs for lost or damaged books.
I understand that failure to follow ILL rules and regulations may result in a temporary suspension of my right to borrow ILL materials.

By checking this box, I verify that I am the cardholder, agree to pay all fees and accept full responsibility for all materials received through ILL

Book Title

Author

Publisher

ISBN

Notes or Source of Reference