Netflix Request Form

Full Name:		*
Course Number:		*
E-mail:
Department:
Date needed:		*
Title:		*
Director:
Year:
I have checked Pac Cat and Summit for this item : *

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Final Notes:

DVDs cannot be placed on reserve.
If a DVD is lost or not returned within 30 days, you will be billed a $75 processing fee.

By submitting this form, I am aware that copyright law requires that the DVD only be used only in a classroom face to face instructional situation..