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 (Required)

Your E-Mail Address (Required)

Your phone number (Required)

Your institution (Required)

Your purchase order number (Required)

Billing address (Required)

Shipping address (Required)

Microfilm Information

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

Title (Required)

Call number (Required)

(ex., A419)

Reel numbers (Required)

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

Date span (Required)

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

Number of copies of each reel (Required)

Film type (Required)

Positive microfilm
Negative microfilm

Special instructions