ADDITIONAL CHARGES - If Images Are for Commercial Reproduction Or If Required Urgently
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REQUEST FOR COPIES
NAME ANU Archives …………………………………………………………………………… ORGANISATIO +61 2 6125 2219 N …………………………………………………………………………… [email protected] ADDRESS …………………………………………………………………………… Menzies Building #2 ………………………………………… STATE ……… P/CODE ……… Fellows Road Canberra ACT 0200 Australia PHONE NO. …………………………………………………………………………… www.archives.anu.edu.au EMAIL ……………………………………………………………………………
□ Research use: I require this reproduction for the purpose of research or study, will not use it for any other purpose, and have not previously been supplied with a reproduction of this material. □ Publication (includes print, website, documentary, broadcasting and exhibition): I will acknowledge the Noel Butlin Archives Centre/Australian National University Archives as the source of this image. I note that additional fees apply to commercial use. Title of publication/product: ……………………………………………………………………………………………… I accept the terms of the Access Agreement published at www.archives.anu.edu.au.
Signature: …………………………………………………………………………… Date: ……………………………
DIGITAL IMAGES Image No. Title of image tiff@600 dpi TOTAL $ $35.00
ADDITIONAL CHARGES - if images are for commercial reproduction or if required urgently
□ Commercial reproduction: $60.50 per image
□ Urgent jobs $35.00 per image (3-day turnaround) – orders normally take 10-14 days
ANU customer R20365 9325 Non ANU customer R20365 8904 Total $
All prices quoted include GST For payment – see over page
Images delivered via Dropbox
A N U A R C H I V E S PAYMENT OPTIONS c CREDIT CARD Type: Mastercard / Visa Preferred for non-ANU Tax Receipt Required: Yes / No payments (do not use ANU purchase Name on Credit Card card) Card Number cccc cccc cccc cccc Expiry Date: cc/cc
Signature of Cardholder c TAX INVOICE Please raise an invoice as per the details on the front of this form. Invoice will be emailed if email address is supplied over page.
Signature cCHEQUE Please attach cheque to this form.
Tax Receipt Required: Yes / No cANU INTERNAL Charge Code ______8504
(GST will be excluded) Signature of Delegate
U number
FOR ARCHIVES USE I confirm that the services requested have been provided
Name
Signature
U number
I confirm that I hold delegation 4.12a or b to authorise the raising of this invoice
Name
Signature Invoice number
U number Customer number