Institutional Subscription Application

Indicate subscription type*

30-day free trial

1-year standard agreement

Institution Name*

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*

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 or range (only IPv4 address format being accepted at this time)*

Special requests?