Family Name*

First Name*

Membership Barcode*

(no spaces)

Daytime Telephone Number

Email Address

Not wanted after

Date

Pickup Branch*

Will you accept a large print book if no other copy is available?

Yes No

Author(s)*

Book Title*

Book Publisher

Year of Publication

(please note that books published in the last 12 months cannot be requested)

ISBN

Where did you see it?

Special requirement/comments

We are charged for some books that we obtain from university, special or interstate libraries and these charges will be passed on. The library will not charge for books obtained from Victorian public libraries.

If a charge ($14.00) applies to the item are you willing to pay for it? *

Yes     By selecting Yes, you are agreeing to proceed with the Inter-library loan request and pay $14.00 if charges apply.
No