College of Eastern Utah
Interlibrary Loan Book Request Form
Title
Author
Publisher
(not required)
Year of Publication
ISBN Number
Lib of Congress Number
(not required)
Patron Information
Patron First Name
Patron Last Name
Library Card: 2 3176 000
(please enter last 6 digits)
Address
City
State
--
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
nnnnn or nnnnn-nnnn
Phone
nnn-nnn-nnnn or (nnn)nnn-nnnn
Email
Are you willing to pay more than $1 for this item?
Yes
No
If yes, how much? $