COPYRIGHT DECLARATION             Date of declaration

Fill in all sections, print the form and sign the declaration. Ensure that the ordering details are completed.
Fill in a separate form for each thesis copy

To:   Document Delivery Librarian, The University of Queensland Library

Please supply me with a copy of the following thesis.

Author

Title

 

 

Thesis No.

Degree

Date conferred

I declare that:
The thesis is required for the purpose of research or study and will not be used for any other purpose. A copy of this thesis has not previously been supplied.

Name

Address

Photocopy/fiche will be

sent to this address

Contact Number

Email Address

 
Signed     __________________________________________

THESIS ORDER FORM
Please fill in a separate form for each thesis copy
Goods and Services Tax not payable on overseas requests.

I wish to order -

   Unbound photocopy - A$65.00 per volume + GSTax $6.50. Total $71.50
   Rush service - Add A$40.00 per volume + GSTax $4.00. Total $44.00
   Microfiche - A$180.00 + GSTax $18.00. Total $198.00
   Overseas Airmail - Add A$55
Total cost    

Method of payment       Please check one box
    Visa
     Cheque
Payable to: The University of Queensland Library
    Mastercard
     A$ Bank Draft
Payable to: The University of Queensland Library

Cardholder Name

Cardholder Number

Expiry date

    Invoice Required

Please fill in all sections, print the form, sign the declaration and either:
Fax to: +61    7    336 56888
or
Send to:
Document Delivery (Theses)
Information Access Service
The University of Queensland Library
Duhig Building
The University of Queensland.
St Lucia Campus.
Qld. 4072 Australia