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Library and Information Services
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Media Order Form


On-Campus Use Only

Use this form when ordering media resources for delivery to your classroom.

Online requests require a minimum of 24 working hours to be processed, Monday thru Friday, excluding holidays and weekends.


Name: Dept: Date: / / (Please enter month/day/year, 01/01/2003 for example.)
Phone: Box #: E-mail:

Media #
Title
Date Needed
Delivery &
Pickup Time
Building &
Room Number
/ /
Room:
/ /
Room:
/ /
Room:
/ /
Room:
/ /
Room:
/ /
Room:
/ /
Room:
/ /
Room:
/ /
Room:
/ /
Room:

Special Instructions:

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