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2. First Name*
3. Last Name*
5. Library Card Number*
6. Phone Number*
8. Email Address
10. Title*
12. Author / Actor*
14. What format do you prefer?*

    1. Book
    2. Audio
    3. DVD
16. Book Type*

    1. Adult Fiction
    2. Adult Non-Fiction
    3. Large Print
    4. Young Adult
    5. Children's Book
    6. eBook
17. Audio Book Type*

    1. CD
    2. Downloadable
    3. No preference
19. ISBN
21. If not selected for purchase, would you like to interlibrary loan the item for a $3.50 fee?*

    1. Yes
    2. No
23. Notes
25. Staff Initials
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27. 1. Receive an email copy of this form.
28. Email address

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29. Submit

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