<p>REQUEST FOR COPIES</p><p>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 ……………………………………………………………………………</p><p>□ 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.</p><p>Signature: …………………………………………………………………………… Date: ……………………………</p><p>DIGITAL IMAGES Image No. Title of image tiff@600 dpi TOTAL $ $35.00</p><p>ADDITIONAL CHARGES - if images are for commercial reproduction or if required urgently</p><p>□ Commercial reproduction: $60.50 per image</p><p>□ Urgent jobs $35.00 per image (3-day turnaround) – orders normally take 10-14 days</p><p>ANU customer R20365 9325 Non ANU customer R20365 8904 Total $</p><p>All prices quoted include GST For payment – see over page</p><p>Images delivered via Dropbox</p><p>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</p><p>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.</p><p>Signature cCHEQUE Please attach cheque to this form.</p><p>Tax Receipt Required: Yes / No cANU INTERNAL Charge Code ______8504</p><p>(GST will be excluded) Signature of Delegate</p><p>U number</p><p>FOR ARCHIVES USE I confirm that the services requested have been provided</p><p>Name</p><p>Signature</p><p>U number</p><p>I confirm that I hold delegation 4.12a or b to authorise the raising of this invoice</p><p>Name</p><p>Signature Invoice number</p><p>U number Customer number</p>
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