Authority Express Initiation Form

Library Name *

Street Address 1 *

Street Address 2

City *

State/Province *

Zip/Postal Code *

Contact Name *

Phone Number *

E-mail Address *

Send invoices to the attention of *

Open Purchase Order # (if necessary)

We plan to submit files beginning this date: *

Month

Day

Year

We will submit about this many records each month *

We will probably submit files *

Daily

Weekly

Monthly

Other

Current rates for Authority Express are:
$10 per file submitted for processing
$.10 per record processed

The library understands:
i) that it will be billed at the end of each month for use of Authority Express during that month
ii) that invoices will be due "net 30 days"

Upon receipt of this form:
i) LTI will assign an account identifier and password to the library
ii) send profiling information to the library

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