Courier Program Sign-up

	COURIER
	Signup Form

Sign up for the Orbis Cascade Alliance Courier!

Please fill in the information requested. This form will automtically be sent to the Orbis Cascade Alliance. You will hear from staff at the Alliance, and from a courier representative.

Today's date:	Name of person submitting form:
Dropsite name:	City, State:
What is your preferred start date?
Type of service: (Please select)

Administrative contact The administrative contact is the person responsible for financial, contract, and related business decisions
Name of Administrative contact:
Phone number: (incl. area code)	Email address:


About this Dropsite In some areas, a Dropsite may be a hub where materials to and from two or more libraries are collected for courier service. Please read information about the opportunities and responsibilities for these dropsites.
This dropsite will serve ... (Please select)
Participating libraries: (separate names with a comma, or leave blank for single-institution dropsite)


Billing information Send invoices to:
Institution or Agency for billing:
Billing address: (line1)
Billing address: (line2)
City, State, Zipcode:
This Billing agency and address are... (Please select)

After you Submit the form, you'll see a Thank You page that includes the information you submitted.