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This table is used for column layout.

Materials Purchase Request


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                                  Patron Request for Purchase
                                                    J.V. Fletcher Library
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Today’s Date: _______  

*Please complete as much information as possible.*

Title: _______________________________________

Author (if applicable):_________________________________

Publisher: ____________________    ISBN:___________________

Format-- Underline One

Book            CD              Books on Tape/CD                Video           DVD


OPTIONAL:

If the Library selects to purchase this item, would you like
to place it on hold? ___________

Name: __________________________    Library Barcode:  _______________

Phone Number: __________________   E-Mail Address: _________________


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Staff Only:  
Route to selector for following collection , "X" next to one

Adult: ____ Juvenile: ______Reference: ______ Fine Arts: _______ Bookmobile: ______


J.V. Fletcher Library | 50 Main Street | Westford, MA 01886-2599
978-692-5555 | www.westfordlibrary.org