ASP Conference Series Subscription Form - Resellers

Please read the price sheet before submitting your online form. Your form submission is secure.

* denotes required field

RESELLER
BILL to

SHIP to
Reseller's ASP Acct. # *

This order ships to the "Bill To" address, no changes
This order ships to you (the reseller) at a different address - fill in below
This order ships to the Inst. Subscriber - fill in below
Agency Name *
(or Institution Name)
Agency Contact *
Street Address *
City *
State *
(Foreign Country submissions please enter "none" if not applicable.)
Zip *
Country *
E-mail *
Phone *
Fax *

 

Institutional Information and Payment
Institution Name :
Institution's E-Resources Contact Person:
E-mail Address:

IP Addresses*:

Check here if no change from current registration

*For single-site campuses only. See Terms and Conditions for allowed access.
Subscription Begin Date:
 Subscription End Date:

Subscription Type and Tier (select one)

Electronic Only Tier 1 $680
Electronic Only Tier 2 $960
Electronic Only Tier 3 $1,200
Electronic Only Tier 4 $1,440

Print & Electronic Tier 1 $1,050
Print & Electronic Tier 2 $1,180
Print & Electronic Tier 3 $1,320
Print & Electronic Tier 4 $1,585

Subscription Cost

$

Shipping Method
(you must select one if you chose a Print & Electronic Tier)

Does not apply
USPS Media Mail $250/year
UPS Ground $450/year
IMS Canada $500/year
IMS Standard $600/year

Shipping Cost

$

 
Wire Transfer Fee ($40) See below for payment methods

Wire Transfer Fee (optional)

$

TOTAL

$

Method of Payment

Please send a Proforma Invoice/Quotation (subscription begins upon receipt of payment)

Wire Transfer (contact ASP Customer Service for instructions; add $40 for bank charges/service fees)

Credit Card:

Visa MasterCard Discover

Card #: Expiration Date:

Phone #: Name on Card:

Submitting order and payment constitutes acceptance of the Terms and Conditions of Use of Electronic Books.
 
 

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