Print this form, fill it out, and bring it to the library.

	Magazine Photocopy Request Form
	Please print clearly
	Date: __________________________
	Your Name ________________________________________
	Your Phone #: ______________________________________
	Address: ___________________________________________
	City/Zip: ___________________________________________
	Magazine Title: ______________________________________
	Article Title: ______________________________________
	Pages: ___________________________________________
	Date of Publication _______________________________
THE SUPPLYING LIBRARY MAY CHARGE TO PHOTOCOPY THIS ARTICLE. IF THERE IS A CHARGE, DO YOU AGREE TO PAY? YES ___ NO ___ UP TO HOW MUCH? $ _____
	Source where you found this information?
	_____________________________________________________
	_____________________________________________________
	For Staff Use Only:
	_____________________________________________________
	_____________________________________________________
	_____________________________________________________
	_____________________________________________________