West Virginia State University, Drain-Jordan Library

Interlibrary Loan Form for Books, Pamphlets, Documents

Loans take 5 - 14 days, (no email or fax submissions)

Date submitted __________________ Date needed by _________________________

Title: ___________________________________________________________________

Author: ____________________________________________ Date Published:____________
Publisher:___________________________________________ ISBN:____________________

Source where you found this title.

. Year .. Volume .. Page . Title .. Year .. Page
Books In Print:
_________________________ Index ___________________________
Forthcoming Books:
_______________________ Cd-rom Index __________________________
Online Catalog
___________________________ Bibliography___________________________
Publisher's catalog
______________________ Other_____________________________

Name:_______________________________ Phone: (h)____________ (w)__________
. (barcode on back of ID)
Address: ______________________________ Library Card#__________________________
. Circle one:
City/State/Zip __________________________ Student Faculty Staff Special Patron
WVSU e-mail address __________________________.

I agree to be responsible for any costs incurred as a result of damage to or loss of this item. I understand that I will be fined at a rate of $1 per day for each overdue item acquired through interlibrary loan. I agree to pay all such fines as levied by the WVSU Library or the lending library. I also understand that books cannot be renewed. (Special card holders may use interlibrary loan books only in the library.)


Patron Signature