2. First Name*
3. Last Name*
5. Library Card Number*
6. Preferred Method of Contact *
   -- Select One --PhoneEmail
8. Email address*
10. Phone Number*
12. Title of Item*
14. Author of Item
16. Format of Item*

    1. Book
    2. Ebook
    3. Audiobook
    4. DVD
    5. Other - Please explain in comments.
18. If the library does not purchase this item, would you like to request an interlibrary loan?*
    -- Select One --Yes, please request an ILL for me.No, thank you.
20. Comments
22. Thank you for your suggestion!

    Selections are based on library policies and constraints. If the library purchases your request, we will notify you.

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