INTERLIBRARY SERVICES, 133 DOE LIBRARY, UNIVERSITY OF CALIFORNIA, BERKELEY CA 94720-6000

Baker Group Subscription Form - Deposit Account

INSTRUCTIONS:
Complete form, enclose payment, and send to:
        BAKER Service, 133 Library, Campus 6000
Minimum deposit is $50.00 - submitted in one of the following forms:
    1. A personal check payable to "The Regents of UC"
    2. An Interdepartmental Order and Charge Form (IOC) made out to "BAKER Service"
    3. Circle one:  VISA/MASTERCARD/DISCOVER/ATM [ ___ VISA ___ MASTERCARD]

Amount of charge $____________________ 

Name as it appears on the card____________________

Card number__________________________

Expiration date _____/_____(mm/yy)



___________________________________
Account Name
(this should be a unique name to the group)


_________________/_________________
Contact Person / Telephone # or e-mail
(to whom account information will be directed)


___________________________________
Department, School, or ORU

___________________________________
Campus Address


___________________________________
Account Principal
(faculty or administrator responsible
for account balance)

_________________/_________________
Office Phone / Message Phone or e-mail


Authorized Users: (Everyone, other than proxies, who will have actual possession of library materials must be on this list and must have his/her own library card.)

Name              Status*               Address             Phone/e-mail             Signature**           Date
                            (F, S, G, P)

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

(List additional names on a separate page and attach to this form.)

* Status:     F = Faculty     S = Staff     G = Grad     P = PhD Candidate 

** I hereby authorize the BAKER Service to act as my proxy borrower in the Library at UC Berkeley. I agree to use BAKER only for my own research needs, and in compliance with the Library rules and policies. When requesting photocopies, I accept full responsibility for compliance with the copyright law of the United States (Title 17 U.S. Code).

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The Regents of the University of California. All rights reserved.
Last updated 07/06/11. Content maintained by: Interlibrary Services staff.