SCAN & DELIVER REQUEST FORM
FOR HEALTH CENTER FACULTY, STAFF AND STUDENTS

Return to: ILL Department - UCHC Library; PO Box 4003; Farmington, CT 06034-4003
UCHC Mail Code 4003
Fax: 860-679-4046

Library staff will photocopy health-related journal articles from the UCHC Library collection QUICKLY and EFFICIENTLY. You may request OVERNIGHT service with delivery available the next day Monday through Thursday or SAME DAY-RUSH service if the request is received by 2pm, Monday through Friday.
OVERNIGHT SERVICE ($3)___  SAME-DAY-RUSH SERVICE ($5)___ (After 25 requests, ILL + Scan & Deliver)

PAYMENT :
Check enclosed payable to UCHC Library __
Department FOAPAL Coding:________________________________

Master Card / Visa Account (min. $3) Expiration Date
________________________________________________________ ___/___

Name_____________________________________Tel._____________________

UCHC Mail Code/mailing address_______________________________________
__________________________________________________________________

DELIVERY:

___I'll pick up the article(s) at the Library Circulation Desk
___Mail to me at the UCHC or mailing address given above.
___PDF via Internet (when possible), e-mail address required

IF WE DON'T HAVE IT : We'll get the article for you from another library. This Interlibrary Loan usually takes 2 working days. ___yes ___no ($10 charge for ILLs if over the limit of 25 at no charge / fiscal year.)

ARTICLE REQUESTED

Journal Title:_______________________________________________________
Volume_________Number____________Year____________ Pages__________
Author of article___________________________________________
Title of article______________________________________________________

NOTICE
WARNING CONCERNING COPYRIGHT RESTRICTIONS
The copyright law of the United States (Title 17, US Code) governs the making of photocopies or other reproductions of copyrighted material. Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specified conditions is that the photocopy or reproduction is not to be "used for any purpose other than private study, scholarship, or research." If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of "fair use," that user may be liable for copy-right infringement. This institution reserves the right to refuse to accept a copying order if, in its judgment, fulfillment of the order would involve violation of copyright law.
LIBRARY STAFF USE ONLY

DATE RECEIVED____________ DATE COPIED_____________