Name _____________________________________________________________
(You may leave blank if you are requesting something personal)

Date ______________________________

Type of Material  
Circle one

Book	Magazine/Periodical	DVD	Other	

Title of item ________________________________________________________

Author ____________________________________________________________

ISBN Number ______________________________________________________

Date Needed _______________________________________________________

For office use only

Review of material request:  Accepted/Denied	Reason:  ________________

Date ordered _______________________________________________________

Company/Vendor ___________________________________________________

For office use only

Your material request has been accepted/denied.  If your request was accepted, please check with the LMC staff within two to three weeks to see if your item has arrived.  Thank you for your request.  

Sincerely,

LMC Staff