Item to be Requested Note: items with a red star MUST be entered. Author's Name (Last, First): Title: * Publisher: Publication Date: ISBN: Choose a Pickup Location: * - Select -MainFordsHenry InmanIselin Source of your information, or comments Last date you will accept this item: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20122013201420152016 Patron Information Note: items with a red-star MUST be entered. Patron Name: * Library Card Number: * Telephone Number with Area Code: * Email: When finished filling out both sections of this form, please complete the Captcha box and then click Submit below. CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.