NELINET Membership Application

If you have any questions or concerns in regards to this membership application, please contact Tim Rivard (1.800.635.4638 x1949 or rivard@nelinet.net) or Susan Abell (1.800.635.4638 x1944 or abell@nelinet.net) at any time.

NELINET Membership Application Instructions

Online Membership Application

Section 1 - Institution Information
Institution:
Library Name:
Main Telephone:
Street Address:
City:
State:
Zip:
Main Contact:
E-mail:
Telephone:
Fax:
URL:
Institution Type:
Current FTE /Population Served:

Section 2 - Membership Categories

Full Members (Voting/Non-Voting)
Affiliate Members
Consortial Sponsor Members

Please select your prefered category:

Section 3 - Tax Status
Subject to Sales Tax
State Sales Tax Exempt Certificate # (Please fax or mail a copy of certificate with signed agreement.)
Section 4 - Payment Information
	Payment Information for Membership Subscription
	Invoice Amount $
	The NELINET Membership Subscription price is customized for your institution. If you have not received your NELINET Subscription quote, please contact Tim Rivard (1.800.635.4638 x1949 or rivard@nelinet.net).
	Purchase Order #	(optional)
	*Payment Options for Future Services*
	Deposit Account Pay as You Purchase (25% surcharge)

Section 5 - Designated NELINET Contacts
	Name:	Contact Type (select all that apply):

	Telephone:	Email:
	Address:
	Name:	Contact Type (select all that apply):

	Telephone:	Email:
	Address:
	Name:	Contact Type (select all that apply):

	Telephone:	Email:
	Address:
	Name:	Contact Type (select all that apply):

	Telephone:	Email:
	Address:
	Name:	Contact Type (select all that apply):

	Telephone:	Email:
	Address:

I accept these terms.
I do not accept these terms.

April 10, 2008

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NELINET, Inc., 153 Cordaville Road, Southborough, MA 01772 1.800.NELINET (tel) 508.460.9455 (fax)