Inter-Library Loan Form

Contact Information
If our policy calls for passing on charges, how much are you willing to pay?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
  __   _____    _  _     ____    ______   ___  
/_ | | __ \ | || | |___ \ | ____| |__ \
| | | |__) | | || |_ __) | | |__ ) |
| | | _ / |__ _| |__ < | __| / /
| | | | \ \ | | ___) | | |____ / /_
|_| |_| \_\ |_| |____/ |______| |____|

Enter the code depicted in ASCII art style.