9. Delivery & Invoicing Information
SHIP TO:
Note: Please give the street address.
Delivery cannot be made to a post office box.
Name____________________________________________________
Title_____________________________________________________
Department _______________________________________________
University/Company/Organization _____________________________
________________________________________________________
Address _________________________________________________
City _____________________________________________________
State ___________ Zip ____________
Phone __________________________ Fax _____________________
E-mail Address ____________________________________________
How is this mailing being used?
Faculty search
Recruitment
Conference
Other ________________________________________________
INVOICE TO:
(if different)
Purchase Order #
(if applicable)__________________________________ (or)
Credit Card
AmEx
Visa
MasterCard
Discover
Credit Card #
Expiration Date:
Name___________________________________________________
Title_____________________________________________________
Department______________________________________________
University/Company/Organization______________________________
________________________________________________________
Address_________________________________________________
City_____________________________________________________
State___________ Zip____________
Phone__________________________ Fax_____________________
E-mail Address____________________________________________
HOW TO SHIP:
UPS...........................................................................................$9.00
UPS 2nd Day.............................................................................$10.50
UPS Overnight...........................................................................$15.00
E-mail attachment......................................................................$25.00
Shipping prices subject to change.
10. Licensing Agreement
Please select type(s) of usage and sign below.
Single usage--I understand that Peterson's lists are supplied for
single use. I understand that I may not reproduce lists I receive from
Peterson's in any form or manner. I will not disclose, transfer, or retain
on paper or electronically all or any part of the list I receive.
Single site, multiple usage--I will use the information multiple times
on a single workstation for mailing purposes within 12 months from
date of receipt. I will not disclose, transfer, or retain all or any part of
the information contained on this diskette. (If multiyear option
requested, check below.)
Multisite, multiple usage--I will use the information multiple times on
multiple workstations for mailing purposes within 12 months from date
of receipt. I will not disclose, transfer, or retain all or any part of the
information contained on this diskette. (If multiyear option requested,
check below.) Number of workstations using data_____.
Multiyear usage--Data updated on anniversary date.
Data licensed for________ years (not to exceed 2 years).
Cost per year________
Authorized Signature________________________________________
Title______________________________ Date_____________________
Peterson's reserves the right to request sample mailing pieces and
to approve or disapprove the release of list(s) to any party. Peterson's
may also require from any mailer a written agreement guaranteeing
appropriate use.
Please complete both sides of this form and fax or mail to:
Peterson's, Data and Lists Department
Princeton Pike Corporate Center
2000 Lenox Drive
Lawrenceville, NJ 08648
8
Call:
800-338-3282 x3410
(Outside the U.S. and Canada, 609-896-1800)
Fax:
609-896-4543
E-mail:
patricia.sheffer@petersons.com
www.petersons.com/products/corp-data.html
