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2. By submitting the completed form, the requester understands that he/she is responsible for a $2.50 handling fee due upon check out, any overdue fines, any charges assessed by the lending library, and the replacement cost of the item plus a $10 processing fee if the item is lost, damaged, or otherwise not returned.

4. First Name*
5. Last Name*
6. Date*
   Date
8. Last 5 digits of your Leander Public Library card*
10. Phone Number*

    (xxx) xxx-xxxx

11. Email Address
13. Title of Item*

    Please give the complete title of the item you are requesting.

15. Author

    Provide the name of the Author, Narrator, Actor, or other creator to help us find the exact item you want.

17. ISBN
19. Format*

    Please specify the type of material you want such as a book, audiobook, music CD, DVD, etc.

Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field