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Media Request Form

If you would like to order a DVD or video, a CD, or other type of media for the library to purchase, please fill out the form below. Please include your name, email address, department, telephone number, and name of college.

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Requester:

Email Address:

Enter a valid email address. Example: name@company.com

Department and/or College:

Phone Number:

Is media title being recommended for a particular course?

If yes, please list the name and course number of the course:

Title of Media:

Publisher/Distrubutor Name and Address:

Price:

Format:

Length of Video (Specify in hours and minutes):

Performer:

Narrator:

Year:

Any Additional Comments or Suggestions?