Full name:......................................................... The annual subscription covers the period up to and including 31 July 2009. Monthly pro-rata adjustments apply to institutions that subscribe part-way through a subscription year. I enclose a purchase order for the amount below to cover the subscription period. .................................... + VAT Purchase Order No......................................................... Full internal postal address for delivery of invoice: ............................................................................................................. ............................................................................................................. SITE REPRESENTATIVE DETAILS Name:.................................................. Job Title..................................... Department:.................................................................... Address:......................................................................... ................................................................................... ............................................................ Post Code............................... Tel no.:................................................. Fax no.:.................................. Email:................................................... AUTHORISATION Name:................................................... Job Title................................. Tel no.:................................................. Fax no.:.................................. Email:................................................... Signature:............................................... Date:........................................
Please return this form by FAX to EDINA: 0131 650 3308; and send the original form and the purchase order form by post to: EDINA, Causewayside House, 160 Causewayside, Edinburgh, EH9 1PR.