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All subscribing institutions should fill out
Part A
Those subscribing as consortium members should also fill out Part B
Forms for ALL members of a consortium MUST be submitted TOGETHER by the Consortium Coordinator.
The subscription period will begin on the first of the month following receipt of this order, together with payment or valid purchase order number, and TWO SIGNED COPIES of the subscription agreement form. Please return all completed forms to: Subscriptions Manager, Bibliography of Asian Studies Online, Association for Asian Studies, 1021 East Huron Street, Ann Arbor, MI 48104 USA; Fax: (734) 665-3801.
Name of Institution: __________________________________________________
Billing Address: _____________________________________________________
_________________________________________________________________
Contact (Name, Tel, E-Mail) ___________________________________________
__________________________________________________________________
Method of Payment:
Purchase Order Number: ______________________________________________
VISA: Account No: _____________________________ Expires: ___/___
MasterCard: Account No: _________________________ Expires: ___/___
American Express : Account No: _________________________ Expires: ___/___
Check Enclosed __ Check # _________________________
Annual Subscription Fee (check one):
Large ($1200): ___
Medium ($900): ___
Small ($700): ___
Very Small ($500): ___
If you are applying as a consortium member, you are eligible for additional discounts; please fill in Part B below.
IP Addresses:
Please list all authorized IP addresses for your institution here. They
should also be sent by e-mail to Lisa Hanselman,
lhanselman@aasianst.org.
The e-mailed IP addresses will be used to establish your connection. The listing here is
as a check and back-up.
_____________ ____________ _____________ _____________ _____________
_____________ ____________ _____________ _____________ _____________
_____________ ____________ _____________ _____________ _____________
Name of Consortium: ______________________________________________
Name of Consortium Coordinator: ____________________________________
Address: ________________________________________________________
________________________________________________________________
Telephone: ____________________________
Fax: _________________________________
E-Mail: _______________________________