Document Delivery payment authorisation
I, the undersigned, authorise
Document Delivery Services to obtain the requested materials.
I guarantee to reimburse the Library with all costs associated with the
request(s).
Date: ___/___/___
Name: ______________________________
Signature: ______________________________
Address: __________________________________________________________________
Contact No.: (work) _________________ (home) _________________
ID Number: ______________________________
Departmental Account No: __ __ __ __ __ __ __ __ __ __ __
__ __
Note: if no departmental
account number is given, the individual named above will be invoiced for
reimbursement of costs.
Departmental Authorisation for the Account Number listed
above:
Name: ________________________________________
Signature: _____________________________________
Item details
Author: ______________________
Title: ________________________
Office Use
| Document Delivery Request |
$12 +GST |
| Rush |
$30 + GST |
| Overseas loan |
$50 + GST |
| Thesis |
variable |
Other (please specify):
Total Cost:
Item received: ____________________________________________
|