Interlibrary Loan Form

This form is for journal articles only. The Melbourne Library Service cannot obtain audio visual items. Books can be requested on a different form.

		* indicates a required field
Family Name:		*
First Name:		*
Membership Barcode:		*
Daytime Telephone Number:
Email Address:
Date not wanted after:
Author(s):		*
Article Title:		*
Journal Title:		*
Journal Issue/Date:
ISSN:
Page Numbers:
Where did you see it referred to?
Special requirements/comments:

I would like to pickup my Inter Library Loan at:		City Library East Melbourne Library North Melbourne Library
Charges
Most lending libraries charge $13.20 to provide a photocopy of an article. We will endeavour to obtain an article from a library that does not charge. If this is impossible the $13.20 charge will be passed on to the borrower.
If the $13.20 charge applies to the item do you wish the library to obtain the item for you? *		Yes No
Copyright
You will need to sign the following copyright declaration when you pick up the item: I have requested a copy of the item described above and declare that I require the copy for research or study and will not use it for any other purpose, and that I have not previously been supplied with a copy of this item by a staff member of the Melbourne Library Service.

The City of Melbourne is committed to protecting your privacy. Any personal information provided to the City of Melbourne on this form will not be used for any other purpose than to request an interlibrary loan. It will not be disclosed to any external party unless required or authorised by law.