Phone:  ______________________________________________________________________
E-Mail Address:  ______________________________________________________________
Room Number:  _______________________________________________________________

Affiliation with the BC Library/Media Center (Check One)

_____ Student    _____ Faculty    _____ Administrator    _____ Parent
_____ Employee   _____ Alumnus   _____Dept. Chair   _____ Librarian

Format (Check One)

_____ Book    _____ Magazine/Journal  _____ Video   _____ Software
_____ Laser Disk   _____ Map   _____ Art Object   _____ Hardware   _____ Kit
Other (Describe):   __________________________________________

Title:    __________________________________________________________________________
Author(s) / Editor(s):   ____________________________________________________________
Publisher (Manufacturer):  _________________________________________________________
City of Publication:  _______________________________________________________________
Publication Date:  _________________________________________________________________
Description:  _____________________________________________________________________
                       ______________________________________________________________________
                       ______________________________________________________________________
Price:  ____________________________________________________________________________

Name:  _____________________________________________________________
Address:  ___________________________________________________________
City/State/Zip:  _____________________________________________________
Phone:  _____________________________________________________________
Fax:  ________________________________________________________________

(To be completed by the librarian. A copy of this form will be returned to the requester upon action.)

_____ Accepted     ____________Date Ordered      ____________Anticipated Arrival
Vendor Used _____________________________________________________________________________
Order Number: ___________________________________________________________________________

_____ Rejected