Please print and fill out the following form.


Send form to:


University of Illinois Library
Attn: Susan Edwards
1408 W. Gregory Drive
Urbana, IL 61801 USA

The Leopoldo Cicognara Library Collection on Microfiche

Subscription Information:
Cost: $42,000.00 USD
Payment Options (check one):
_____ One time payment of $42,000
_____ Two payments of $21,000* (paid over two years or less)
_____ Three payments of $14,000* (paid over three years or less)
*Microfiche collection will be shipped in two or three sections if a payment plan is used.

Method of Payment:
(Indicate preference)
_____ Check
_____ Wire Transfer
_____ Credit Card (MasterCard or Visa only)

An invoice will be sent to you once we receive your subscription request.

Subscriber Information

Name of Institution: ______________________________________________________________

Contact Name: __________________________________________________________________

Billing Address: _________________________________________________________________

City: _________________________________ State: __________ Zip code: ______________

Country:________________________________ Postal Code: _________________________________

Telephone: __________________________ FAX: _____________________________

SHIPPING ADDRESS FOR MICROFICHE (if not the same as above):

Name of Institution: ______________________________________________________________

Contact Name: __________________________________________________________________

Street Address: ___________________________________________________Office/Room # ________

City: _________________________________ State: __________ Zip code: ______________

Country:________________________________ Postal Code: _________________________________

Telephone: __________________________ FAX: _____________________________

HOME