Video Order Request Form

Please use this form to request a video purchase for the Bertrand Library collection for classroom use.

Name:
Email:
Department:
Phone:

Date the video is needed:
Title:
Year Produced:
Actor/Actress:
Do you want to be notified when the video arrives?
Yes No
Series:
Price:
For use in:
Justification for ordering:
Required viewing for class
Supplemental
Recommended
Purchase Source (if known):
Notes (about the order):