Form for NEW Library Subscription Service (LSS) Subscribers

Please fill out this electronic form if you wish to become a subscriber to the SUERF Library Subscription Service, including payment details. Please note that the Annual subscription fee is EUR 250 (Europe) or EUR 300 (Rest of the World).

Title:
Name of Institution/Library:
Name of Contact Person:
Position held:
Department:
Address:
City:
ZIP:
Country:
Telephone:
Fax:
Email:
Billing Address: (if different)
Payment:	The annual subscription fee will be paid into the SUERF account. Iban code: BE29 439-7946987-64, Swift code: KREDBEBB, KBC Bank N.V., Arenbergstraat 11, 1000 Brussels, Belgium.
Payment:	I wish the annual subscription fee to be charged to my credit card (details below)
Type of Creditcard:
Creditcard number:
Expiry date (MM/YY):
Name of Cardholder:

<<< Back