Material Purchase Request Form
  1. Poplar Creek Public Library card holders only may use this form to request materials for the library to purchase.

    Fields marked with * are required.

  2. Author/Composer/Performer*
    Please provide an author, composer, or performer.
  3. Title*
    Please provide a title.
  4. Publisher
    Please provide a publisher.
  5. Publication Date
    Please provide a publication date.
  6. Edition
    Please provide the edition.
  7. ISBN
    Please provide the ISBN.
  8. Preferred Format
    Please provide your preferred format.
  9. Patron Name*
    Please provide your name.
  10. Library Card Number*
    Please provide your library card number.
  11. Phone Number*
    Please provide your phone number.
  12. E-Mail Address*
    Please provide your e-mail address.
  13. Additional Comments
    Please provide your comments.
  14. For security purposes, please enter the code below into the box.*
    For security purposes, please enter the code below into the box.
      New codeCode typed incorrectly
  15.