Interlibrary Loan Request

First Name

Last Name

Home Address

City

Phone

Email

Preferred contact method

Phone

Email

Library Card Number

Date beyond when material will not be useful

Type of material requesting?

Book

Periodical/Microfilm

Audiobook

CD

DVD

Periodical/Microfilm Information

Article title

Author (Last Name, First)

Periodical

Volume

Number

Pages

Publication Date

ISSN

Book Information

Title

Author (Last Name, First)

Publisher

Copyright Date

ISBN

Audiobook Information

Title

Author (Last Name, First)

Publisher

Copyright Date

ISBN

CD Information

CD Title

Artist / Band

Release Date

Additional Information

DVD Information

DVD Title

Director(s)

Release Date

Additional Information

Are you willing to pay additional fees if the lending library requires it?

No

Postage only

Yes

If yes, what is the maximum amount you are willing to pay

Pick up location

I acknowledge that:

I am responsible for paying any additional fees imposed by lending library.
Fees will be posted to my library account.
I am responsible for lost and damaged charges.
I am a resident of Des Moines, Windsor Heights, or rural Polk County

I agree to the terms and conditions of the Des Moines Public Library’s Interlibrary Loan service.

DMPL Closed This Sunday

Interlibrary Loan Request