Member Discount Quote Request Form

Please fill out this form completely, so we may properly process your request.

Product(s) *

Vendor *

Are you an Amigos member? *

Yes

No

Institution *

Institution name

Library

Library name if different from institution

Mailing Address *

123 Anywhere Street

City *

State *

TX, LA, NM...

Zip Code *

XXXXX-XXXX

Subscription Contact Name *

email address *

Fax

XXX-XXX-XXXX (including area code)

Telephone *

XXX-XXX-XXXX (including area code)

Type of Institution *

What type of institution is it?

Number of FTE's *

or population served, or cardholders, if a public library

Simultaneous Users

OCLC Symbol

Number of sites

Type of Quote *

New Order

Renewal

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