New Jersey State Library

To apply, please complete and return the following by February 15, 2004 to:
Scherelene Schatz, Library Development Bureau
New Jersey State Library, PO Box 520
Trenton, NJ 08625-0520

APPLICATION FOR ILL NET LENDER REIMBURSEMENT PROGRAM
January-June 2004

Applicant Library: _________________________________________________________

Address: __________________________________________________________

____________________________________________Zip___________

Project Director ____________________________________________________

Telephone ____________________________________________________

Member of the ____________________________________________
Regional Library Cooperative.

The library agrees to report only eligible loans as defined above (see guidelines for definition of eligible and ineligible loans). Yes_____No_____

The library agrees to maintain records of loans claimed for compensation for three years and to make these records available for audit if requested. Yes_____No_____

Payment can be made directly to the library or as a credit to your PALINET account. Please indicate your preference.

_______I prefer payment by check to the library.

_______I prefer payment as a credit to the library's PALINET account.

________________________________________________
Library Director's Signature