Contact: ________________________________________________
Title: ___________________________________________________
Institution: _______________________________________________
Address: ________________________________________________
City: ___________________________________________________
State: ___________________________ Zip: ___________________
Phone: ________________________ Fax: _____________________
Email: __________________________________________________
Payment Type: Check: [ ] Purchase order: [ ] Invoice: [ ]
|
|
Qty |
Price each |
Total |
|
MARC Report |
|
$ |
|
|
Updates and Support (first 12 months) |
|
FREE |
FREE |
|
Updates and Support (Additional 12 months) |
|
$ |
$ |
|
Sales
Tax ( |
|
$ |
$ |
|
TOTAL |
|
|
$ |
Tax exemption # (if Florida-based): _
Bibliographic Utility (e.g., OCLC, ITS, etc.): __
Local System (e.g., Dynix, ITS, Winnebago, etc.):
Library Type: Academic [ ] Public [ ] School [ ] Special [ ] Other:
Please sign here: Date of order:
Thank you for your order
The MARC of Quality
5880-A Highway A1A,
Phone: 1-800-560-6272
FAX: 321-676-1904
Email Address