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 -

   Pdf on CD - A$65.00 per volume + GSTax $6.50. Total $71.50
Overseas Airmail - Add A$12.50
Total cost    

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

Cardholder Name

Cardholder Number

Expiry date

    Tax Invoice Transaction Receipt Required. (Please indicate the name required on the receipt.)

Please fill in all sections, print (or scan) the form, sign the declaration and either:
Fax to: +61    7    336 56888
or
Email to: dds@library.uq.edu.au
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
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