Title:

Author(s):

Publisher:
Place of Publication:
Publication Date

ISBN or ISSN (if available):

This Edition Only? Yes No

Additional Information (Required)
Today’s Date: (Date Format: MM/DD/YYYY, MM = Month, DD = Day of Month and YYYY = Year; example: 08/28/2008 for August 28, 2008)
Date after which this book will no longer be useful to you (if any):

To be used for (check one):
Personal Information Course
Course title & number:

NOTICE CONCERNING COPYRIGHT! In submitting this request, you agree to the following: The Copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproduction of copyrighted materials. Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specified conditions is that the photocopy or reproduction 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. Benedict College reserves the rights to refuse to accept a copying order if, in its judgment, fulfillment of the order would involve violation of the copyright law. I agree to comply with these conditions (listed above):

Request by (Name):
Last    First MI
Email address:
Phone Number (including Area Code):