Photocopy Request Form
/Library Staff Use Only
WO1 / PRIN
Journal Title / Academy Library and Information ServiceSwindon & North Wilts Health & Social Care Academy
Great Western Hospitals NHS Foundation Trust
Great Western Hospital
Marlborough Road
Swindon
SN3 6BB
Tel: 01793 604596/3 Fax: 01793 604594
Year / Volume No. / Part No. / Pages
Author and Title of Article
Copyright Declaration
I declare that:
Date………… / A) I have not previously been supplied with a copy of the same material by you or any other librarian.
B) I will not use the copy except for research for a non-commercial purpose of private study and will not supply a copy of it to any other person; and
C) to the best of my knowledge no other person with whom I work or study has made or intends to make, at or about the same time, a request for substantially the same material for substantially the same purpose
Signature…………………………………………… / Date of Request:
Applied to / Reason for non-supply. / Date
In the Library / SENDS
NHS ejournals / NULJ
Internet / BLDSC
SWIMS
Finance: Cost Personal Department
Date Completed:
Name: (CAPITALISED) / Job Title/Profession:
Address: / Name of University:
Library Card Number:
U0
¨ Send it to me
¨ Phone/bleep me / Bleep/Phone Number:
¨ Email me - email address:
Photocopy Request Form
/Library Staff Use Only
WO1 / PRIN
Journal Title / Academy Library and Information ServiceSwindon & North Wilts Health & Social Care Academy
Great Western Hospitals NHS Foundation Trust
Great Western Hospital
Marlborough Road
Swindon
SN3 6BB
Tel: 01793 604596/3 Fax: 01793 604594
Year / Volume No. / Part No. / Pages
Author and Title of Article
Copyright Declaration
I declare that:
Date………… / A) I have not previously been supplied with a copy of the same material by you or any other librarian.
B) I will not use the copy except for research for a non-commercial purpose of private study and will not supply a copy of it to any other person; and
C) to the best of my knowledge no other person with whom I work or study has made or intends to make, at or about the same time, a request for substantially the same material for substantially the same purpose
Signature…………………………………………… / Date of Request:
Applied to / Reason for non-supply. / Date
In the Library / SENDS
NHS ejournals / NULJ
Internet / BLDSC
SWIMS
Finance: Cost Personal Department
Date Completed:
Name : (CAPITALISED) / Job Title/Profession:
Address: / Name of University:
Library Card Number:
U0
¨ Send it to me
¨ Phone/bleep me / Bleep/Phone Number:
¨ Email me - email address: