Fillable Ill Interlibrary Loan Form (Gogebic Community College)

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Ill Interlibrary Loan Form (Gogebic Community College)

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GOGEBIC COMMUNITY COLLEGE LIBRARY
INTERLIBRARY LOAN REQUEST FORM
(THIS FORM MUST BE FILLED OUT AND SIGNED IN PERSON: NO TELEPHONE REQUESTS ALLOWED)
Date of request
Item not wanted after
No
Yes
Are you willing to pay for this item if a fee is charged?
If YES, indicate the maximum you are willing to pay:
$5 - 10
Over $20
Name
Student
Alumni
Faculty/Staff
Address
Phone (home)
(work)
Card #
BOOKS
Title
Author(s)
Publisher
Publication Date
Call Number
Lending Library
PERIODICAL ARTICLE COPY
Journal Title
Article Title
Author(s)
Volume
Issue Number
Pages
Date
Where did you find this citation? (MUST BE COMPLETED) Write complete citation or attach printout of citation from VOYAGER or
periodical datatbase.
Title
Vol.
No.
Page
Date
NOTICE: COPYRIGHT RESTRICTIONS: The copyright law of theUnited States(Title 17 USC) governs the making of photocopies or other reproductions of
copyrighted material. Under certain conditions specified in the law, libraries are authorized to furnish a photocopy. One of these specified conditions is that the
photocopy is not to be “used for any purpose other than private study, scholarship or research.” If a user makes a request for, or later uses, a photocopy or reproduction
for purposes in excess of “fair use,” that user may be liable for copyright infringement. The library reserves the right to refuse to accept a copying request if, in the
judgment of the library staff, fulfillment of the request would involve violation of the copyright law.
Requestor's affirmation: TO THE BEST OF MY KNOWLEDGE, MY REQUEST IS IN COMPLIANCE WITH COPYRIGHT LAW
TO BE SIGNED WHEN REQUEST IS SUBMITTED:
REQUESTOR'S SIGNATURE
OFFICE USE
Date ILL placed
Date ILL received
Lending Library
Date patron notified
Date of patron pickup
DUE DATE
Date returned to lending library
TO BE SIGNED WHEN PATRON PICKS UP BORROWED ITEMS:
I agree to return the item I am borrowing by the DUE DATE above. If I fail to return the item on time, I agree to pay all
charges imposed by the lending library and any service charges GCC may incur as a result of this transaction.
Date
Patron signature
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Ill Interlibrary Loan Form (Gogebic Community College)

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Completed 17 September 2020

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