Institutional Subscription Application

Indicate subscription type*

30-day free trial

1-year standard agreement

Institution Name*

Institution Name for the license agreement (read description below this field)*

Some institutions have requirements that license agreements list the institution in a manner such as "Board of Regents for the University of Smith." If your institution has such a requirement, please note that here, otherwise, just enter "N/A" or "same".

Library Name*

Name*

First Last

Job Title*

Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Provide a link to your school*

Business Phone*

Fax number

Skype user name

Email address for invoice submission*

Name of invoice contact person*

First Last

Number of voice students*

Preferred Start Date*

Preferred payment type (US & CANADA)*

Preferred payment type (INTERNATIONAL)*

EBSCO Representative Name*

First Last

EBSCO Representative Email*

WT Cox Representative Name*

First Last

WT Cox Representative Email*

Does your institution offer graduate study in voice?*

Yes

May we show your institution's name on our Institutional Subscriber's page?*

Yes

IP address(es) or range(s) WITHOUT CIDR (only IPv4 address format being accepted at this time)*

Please provide the IP address(es) and/or range(s) in IPv4 format without using CIDR. Example: 123.45.56-57.0-255. If you offer off-campus access via a proxy server, please provide the single IP address for that server as well.

Special requests?