Kansas Library Express
Interlibrary Courier Service
2010-2011 Participant Directory Form
Library information: (Please print)
Library Name: _______________________________________________________________________________
Physical Address: ___________________________________________________________________________
City: _________________________________________________________ State ________ Zip_________
Phone (With Area Code): ________________________________
Billing contact information:
Contact Name: _______________________________________________________________________________
Billing address: ______________________________________________________________________________
City: ________________________________________________________ State _________ Zip _________
Phone (With Area Code): ________________________________
Billing Email: ____________________________________________________________
Courier/Ill contact information:
Contact Name(s): ____________________________________________________________________________
Phone (With Area Code): __________________________________
Courier contact email: ____________________________________________________
(Include all names and email addresses for staff who should receive courier-related
messages and reminders.)