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ORDER FORM

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, payment, 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, 825 Victors Way, Suite 310, Ann Arbor, MI 48108 USA; Fax: (734) 665-3801.

PART A: (to be filled out by all subscribers)

Name of Institution: __________________________________________________

Billing Address: _____________________________________________________

_________________________________________________________________

Contact (Name, Tel, E-Mail) ___________________________________________

__________________________________________________________________

Method of Payment:

VISA: Account No: _____________________________ Expires: ___/___

MasterCard: Account No: _________________________ Expires: ___/___

American Express : Account No: _________________________ Expires: ___/___

Check Enclosed __ Check # _________________________

Annual Subscription Fee (check one):

Large ($1,320): ___

Medium ($990): ___

Small ($770): ___

Very Small ($550): ___

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@asian-studies.org. The e-mailed IP addresses will be used to establish your connection. The listing here is as a check and back-up.

_____________ ____________ _____________ _____________ _____________

_____________ ____________ _____________ _____________ _____________

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PART B: (to be filled out only by institutions subscribing as consortium member)

Name of Consortium: ______________________________________________

Name of Consortium Coordinator: ____________________________________

Address: ________________________________________________________

________________________________________________________________

Telephone: ____________________________

Fax: _________________________________

E-Mail: _______________________________