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Item Suggestion Request Form

2. Patron First Name

3. Patron Last Name

5. Email Address*

7. Item Type*
   -- Select One --BookAudio BookLarge Print BookMP3DVDBlu-RayVideo GameOther *Please explain in notes

8. Publication/ Release Date

10. Title*

12. Author (First &Last Name)

14. Series?

    Is this item apart of a series? If so, what is the series title?

15. Number in Series

    If this item is in a series, please indicate which number in the series the item is.

17. Notes

19. **PLEASE NOTE
    **Please note that submission of request does not guarantee the purchase of said item, but it will definitely be considered in our order purchases.**

    **Please note that submission of request does not guarantee the purchase of said item, but it will definitely be considered in our order purchases.**

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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field