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Entry #34222
Proxy Request
Submitted: 2025-01-16 22:36:30
Form Fields
Your Name
ID: 8
First: Iulia
Last: Colibaba
Your vNumber
ID: 5
V00402610
Email
ID: 17
Email address of person you are authorizing to check items out
ID: 7
Name of the person you are authorizing
ID: 9
First: andrei
Last: colibaba
When should the authorization should expire?
ID: 12
01/01/2035
Consent
ID: 14
Consent: 1
Text: I understand and agree to the above
Description: 8