JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Materials Request
Please fill in all sections, including as much information as possible.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Once available, I will pick up the material at: (choose only one location)
*
Choose
Brillion Public Library
Chilton Public Library
Kiel Public Library
Lester Public Library (Two Rivers)
Manitowoc Public Library
New Holstein Public Library
Requestor name
*
Your answer
Library Card Number
*
Your answer
Phone number
*
Your answer
E-mail
Your answer
Where did you hear about this item? Please provide a link, if possible.
Your answer
Title of item:
*
Your answer
Author/Artist/Performer:
*
Your answer
Type of material:
*
Choose
Book
Book - Large Print
Book on CD
Music CD
DVD
eBook
eAudiobook
Other
If Other, please enter type:
Your answer
Publishing Date:
Your answer
Edition preferred:
Your answer
If you need this item by a specific date, please specify?
MM
/
DD
/
YYYY
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report