NELINET E-resources Order Form

Member Order Form
Contact Information:
Contact Name:
Library/Institution Name:
OCLC Symbol:
Shipping Address:
City:
State:		Zip:
Billing Address (if different from above):
City:
State:		Zip:
Phone Number:
Fax:
E-mail Address:
Technical Contact Information:
Contact Name:
Phone Number:
Fax:
E-mail Address:
Membership Information:
Member Type:
Institution Type:
Official Representative /Authorized Person Name:
Official Representative /Authorized Person E-mail:
Product Information:
Vendor:
Database:
Subscription Dates:
Price:
User Population/Fall FTE/ Employee Count/ Simultaneous Users:
IP Addresses :

Payment Information:
NELINET debits your Core (C) account for these charges. To apply charges to a different account, please indicate the account letter .
Select one payment option below:
	An institution check will be mailed.
	Debit my deposit account.
	I want to prepay, please send an advance invoice (Prices may change without notice.)
	Invoice for payment at a later date (NELINET will add on an invoicing charge to the purchase price.)
Payment in advance provides the lowest price. You will receive invoice notification when the product has been delivered to your institution, and charged to your account. Electronic Resources carry an additional invoicing charge if there is not sufficient money on account when the order is invoiced. NELINET will not issue refunds or credits beyond the individual vendor refund policy.

March 21, 2008

| Back | Top of Page | Home |
NELINET, Inc., 153 Cordaville Road, Southborough, MA 01772 1.800.NELINET (tel) 508.460.9455 (fax)