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 | $16.50 (GST included) |
| Rush | $33 (GST included) |
| Overseas loan | $55 (GST included) |
| Thesis | variable |
Other (please specify):
Total Cost:
Item received: ____________________________________________
