(Attachment to Agreement dated...............................) Product Title.............................................................. ISBN....................................................................... Components: CD-rom Diskettes Manual Other (specify) Site: Academic department name (1)........................................................................ Department contact......................................................... Total no of staff.......................................................... Total no of students....................................................... Academic department name (2)........................................................................ Department contact......................................................... Total no of staff.......................................................... Total no of students....................................................... Academic department name (3)........................................................................ Department contact......................................................... Total no of staff.......................................................... Total no of students....................................................... Academic department name (4)........................................................................ Department contact......................................................... Total no of staff.......................................................... Total no of students....................................................... Academic department name (5)........................................................................ Department contact......................................................... Total no of staff.......................................................... Total no of students....................................................... Full Site License: For 6 or more departments, or for commercial organizations, a Full Site License is available. Tick here for Full Site License ......... Main address of institution ........................................................................... ........................................................................... ........................................................................... ........................................................................... Delivery address (if different from above) ........................................................................... ........................................................................... ........................................................................... ........................................................................... Invoice address FAO Order reference number.................... ........................................................................... ........................................................................... ........................................................................... ........................................................................... Other addresses at which the Product will be used ........................................................................... ........................................................................... ........................................................................... ........................................................................... ........................................................................... Main contact name and address Telephone number................... ........................................................................... ........................................................................... ........................................................................... ........................................................................... ........................................................................... Term of Agreement: Single use One semester One year Two years Unlimited Fee: The Fee for the Term stated above, for the rights transferred in the Agreement, shall be .................. Signature: .......................................................................... .......................................................................... Authorised representative of Licensee Authorised representative of Wiley
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