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Application for redeeming interlibrary loan vouchers

[ print this form onto your company's letterhead and return it completed with your vouchers to be redeemed ]

Membership number:
Name of institution:
Vouchers being redeemed
number of vouchers	face value of voucher	sub total
	x $12.00 =
	x $9.00 =
	x $6.00 =
	x $3.00 =
	x $1.00 =
	x $1.20 =
	x $0.30 =
Cheque is made payable to the institution's name. Send the cheque to:
Attention of:
Street addresss or PO Box:
Suburb or town:
Postcode:

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