Please fill out this form for your ZIP Book or Interlibrary Loan Request.

1

Your Information

 *

Your Information

Your Library Card #

Your Name

Mailing Address

City, State and Zip Code

Your Phone #ext.

Your Email

2

Item Requested

 *

Item Requested

Author or Editor

Title

Publisher and/or Date

3

Format

Format(Select an Answer) Standard print book Audiobook - Book on CD Audiobook - MP3 Large print book Music CD DVD Article from periodical

4

Pick-up Library Location

Pick-up Library Location(Select an Answer) Ukiah Branch Library Fort Bragg Branch Library Willits Branch Library Coast Community Branch Library Round Valley Branch Library Mendocino Bookmobile Laytonville Branch Library

5

*

I agree to share my contact information including my name and mailing address with the third-party vendor(s) supplying the Zip Book Request

6

Agree to $2.00 Interlibrary Loan Fee?

If the item I want cannot be requested for free through ZIP Books, I would like to pay a $2.00 fee to have the Library perform a standard Interlibrary Loan search for this item. I understand that this fee is non-refundable whether or not the item I requested is available. (If the lender also charges fees, the Library will notify you of the amount before we proceed any further.)

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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