Appeal of Library Charges Form This form applies to charges from all campus libraries with the exception of the State Historical Society Library or equipment checked out through the Equipment Checkout System. Please note that lost book charges cannot be appealed. For any charges billed more than one month ago, you should call the circulation office at (608)263-7360 during office hours or use this form to contact us before appealing. 11 digit UW ID:*Information about campus ID cards here: Illustrations of different IDsYour name:Street Address:City:State:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip code:Phone:Email:*You will receive a notification of the decision of the appeal board via email. Call (608)263-7360 during office hours or use this form if you have questions. If you do not receive a reply within three weeks, it is your responsibility to contact the office. Reason for Appeal:*First Appeal (explanation optional)Recall Notice Not Received (explanation optional)Medical (brief explanation and/or supporting documentation required)Family Emergency (brief explanation required)Other (brief explanation required)Question (please explain)Explanation Statement:Type your explanation, statement, or question in this area. If you wish to contest only part of your charge, clearly state which part you are appealing.NameThis field is for validation purposes and should be left unchanged.
