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2. First Name
3. Last Name
5. Street Number
6. Street Name
7. Street Type
8. Apt #
10. City
11. State
12. Zip
14. Home Phone Number
15. Work Phone Number
16. Date Needed
18. Author First Name
19. Author Last Name
21. Title
22. Year of Publication
    Year of Publication
24. Other Important Information
26. Source of Information (if available)
28. Patrons requesting interlibrary loans must have a current Keene Memorial Library card free of any delinquencies or fines. The charge for each interlibrary loan item will be the cost of return postage and any other charges the lending library requests. The patron must present library card when picking up material. These items are to be picked up and returned to the Circulation Desk. DO NOT RETURN ITEM IN BOOK DROP. If the material is lost or damaged, or returned late, the patron is held liable for any charges imposed by lending library. Patrons must check for an extension a week before due date. Patrons who do not comply will lose any further interlibrary loan privileges. By typing your name you will abide by copyright law and terms stated above.
30. Checkbox*

    I understand that I must have a current library card and that account must be free from any fines or fees. If my account has any fines or fees, my request will not be processed.

    1. I understand
32. Name as complying to terms stated
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36. 1. Receive an email copy of this form.
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