Institutional Subscription Application

Please review our licensing guidelines prior to submitting an application.

Institution Name*

Institution Name for the license agreement (PLEASE 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, please re-enter your institution's name here. WHAT YOU TYPE IN THIS FIELD IS WHAT APPEARS ON YOUR AGREEMENT.

Library Name*

Job Title*

Provide a link to your school*

Business Phone*

Fax number

Skype user name

Email address for invoice submission*

Number of voice students*

Preferred Start Date*

Preferred payment type (US & CANADA)*

Preferred payment type (INTERNATIONAL)*

EBSCO Representative Email*

WT Cox Representative Email*

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.

How did you hear about IPA Source?*

Special requests?