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Entry #45179
Proxy Request
Submitted: 2025-09-04 18:23:39
Form Fields
Your Name
ID: 8
First: Benito
Last: Monroy
Your vNumber
ID: 5
V00403144
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
V00403014
Name of the person you are authorizing
ID: 9
First: Nitza
Last: Castro
When should the authorization should expire?
ID: 12
09/30/2026
Consent
ID: 14
Consent: 1
Text: I understand and agree to the above
Description: 8