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Entry #44839
Proxy Request
Submitted: 2025-08-12 23:07:19
Form Fields
Your Name
ID: 8
First: Maren
Last: Anderson
Your vNumber
ID: 5
V00174336
Email
ID: 17
Email address of person you are authorizing to check items out
ID: 7
vNumber of the person you are authorizing (if applicable)
ID: 11
V00018912
Name of the person you are authorizing
ID: 9
First: Charles
Last: Anderson
When should the authorization should expire?
ID: 12
08/01/2040
Consent
ID: 14
Consent: 1
Text: I understand and agree to the above
Description: 8