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Arizona Health Sciences Library
Registration Form
for AHSL Corporate Card
Eligibility for AHSL Corporate Card: Must be a company or business in Arizona.
    *
Indicates a required field
* Business Name
(Please include full name of business)
* Business
address
* City, State, ZIP
  Contact Person
   
Work/ business phone number Day  Eve.
(Please include area code)
E-mail
*

Please provide names of users of corporate card

       

           

* Payment Information

There is an annual fee of $500 for the AHSL Corporate Card for up to 10 users (add $50 per user over 10). Please indicate how you wish to pay:

I will call (520-626-4398) or fax (520-626-2831)with my Visa or MasterCard account name, number and expiration date. (This is not a secure site--do not send credit card numbers in this form)

I will mail my check with a printed copy of this form to the address below.

Please send me an invoice for $500.00.

Once payment is received, allow 1-2 days for processing your registration.

Loansome Doc I am registered with Loansome Doc, the document delivery service sponsored by the National Library of Medicine.
Additional Comments:
   
By sending this AHS Corporate Card registration, I acknowledge responsibility for all library materials checked out on my card and for all Interlibrary Loan fees that I may incur.


For assistance or comments,
email Javad Basij or call 520-626-4398

Please print off this form and mail it with a check to:
Loan Services
Arizona Health Sciences Center
1501 N. Campbell Avenue
P.O. Box 245079
Tucson, AZ 85724-5079

Return to AHSL Corporate Card page