Library: Select your library Amsterdam Free Library Canajoharie Library and Art Gallery Community Library (Cobleskill) Fort Hunter Free Library Fort Plain Free Library Frothingham Free Library (Fonda) Gloversville Public Library Johnstown Public Library Margaret Reaney Memorial Library (St. Johnsville) Middleburgh Library Mohawk Valley Library System Northville Public Library Schoharie Free Library Schenectady County Public Library Sharon Springs Free Library

Staff Name:

Email (this should always be xxx-ill@mvls.info):

Need-by date:

Maximum cost patron is willing to pay (for non-medical/health-related requests only)** :

Verified in? (where did you find the citation or reference for this title):

Journal Title:

Article Title:

Article Author:

Volume/Issue Number:

Issue Date:

Pages:

Journal ISSN:

Copyright compliance - see https://www.nh.gov/nhsl/nhais/copyrightinfo.html for assistance CCL CCG

Additional Notes:

** Advise your patrons that loaning libraries may charge a loan fee, normally $25 or less. Requesting libraries will be responsible for paying any loan fees incurred by GLE on behalf of your patrons. GLE will follow up with the requesting library prior to requesting an item with a loan fee higher than the amount indicated on this form.