This form must be attached to your purchase order.
All requested
information must be provided for us to process your order.
PO must be made out to: WiLS, 728 State Street, Room 464, Madison WI 53706.
Contact Person:______________________________________________
Library:_____________________________________________________
Street:_____________________________________________________
City, State, Zip:______________________________________________
Phone:________________________Fax:_________________________
Email: __________________________IP Range: _________________________
| Title Source 3 Gold | Price | |
| Full
Service, single ID for Public or Academic Library |
$1,675.00 | _________ |
| Additional concurrent users | $270 x #_____ | _________ |
| Total | _________ |
NOTE: K-12 Libraries should order directly from the Vendor