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2. First Name*
4. Last Name*
6. Library Card Barcode Number*
8. Telephone Number (e.g. 555-555-5555) *
10. Email Address
12. Title of item*
14. Is item an article from a magazine or other Periodical*

    1. YES
    2. NO
16. If yes please indicate the title of the periodical.
18. Author of Item
20. Publisher/Date
22. ISBN
24. Any additional information you can provide us such as format, call number, volume number, issue number, editor information, etc.
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26. 1. Receive an email copy of this form.
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