ILL Request: Microfilm

							First Name*
						
							Last Name*
						
							Library Card Number*
						
							Address*
						
							Phone*
						
							Phone type
						
							Email*
						
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Statement of ResponsibilityBy 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.

							I agree to pay the basic fee of $3.00 plus any additional fees charged by the lending library, up to
						
							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*
						
yes

							Title*
						
							Date Range*
						
							Series and/or Roll Numbers*
						
							Notes or Source of Reference*
						
NOTE: Borrowed microfilm may only be used at the Decatur Library.