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Microfilm Duplication Request Form

Please submit a separate form for EACH title (A number) that you are requesting.

All fields must be completed. If you do not have information for a field, please type none in the box.

Your name

Your E-Mail Address

Your phone number

Your institution

Your purchase order number

Billing address

Shipping address

Microfilm Information

Enter the information that you found in the UW Microfilm Print Masters Inventory in the spaces below

Title

Call number (ex., A419)

Reel numbers (ex., 1-5, 8, 10, 12-15)

Date span (ex., 1/1/1997-12/29/1999)

Number of copies of each reel

Film type

Positive microfilm
Negative microfilm

Special instructions