E-Book Reader Request Form

E-Book Reader Request Form
Rules:
1. E-book readers should be served in the request order.
2. You cannot hold onto an e-book reader more than a month.
3. Once you return the e-book reader and in noone else is waiting, you can have it back 1 day after. You still need to fill this request form.
Name
First NameLast Name
Email
example@example.com
Request Date
MonthDayYear
DateHourMinutesAM/PM Option
How long will you keep the e-book reader?
1 Week2 Week3 Week4 Week
Should be Empty: