(PRINT this order form and post it)
Col.Sec. in-letters re Mental/Benevolent Asylum patients and others

Request Number Print SURNAME, Given Name, Year:Code exactly as shown in the index.  If the same name is listed more than once, write each entry on a separate line.
1  
2  
3  
4  
5  
Total = ............. entries
As a professional genealogist, I can provide a photocopy from the original source, for a fee.  The fee is 'per entry', not 'per name', so if the same name is listed twice, that is two entries.  Allow up to 8 weeks for a reply as I am often away for family reasons.

* If you live in Australia: one entry $15, extra entries $7 each (including postage).

* If you live overseas: one entry AUD$18, extra entries AUD$8 each (including postage).

$See the list of payment methods available (my address is on that page).

PRINT this page, ENTER details below, and POST the page with payment or bank/PayPal receipt.

I have read the information about the sources from which this index was compiled.  I also understand that: (1) Copying fee is 'per entry', not 'per name' (so if the same name is listed twice, that is two entries); (2) Fee includes copies of up to two pages per entry, postage, a handling charge, and (if applicable) bank fees for foreign currency; (3) If there are more than two pages please copy additional pages and invoice me for the balance owing, up to a maximum of $............ (specify a value).

Payment enclosed:  (amount) .................. in the form of (circle the one that applies)  PayPal receipt, or bank receipt, or Australian dollars cheque, money order or cash, or pounds sterling cheque or cash.

(PRINT clearly) Name:
Postal address:
Email:
Alternative email:

Post with payment or receipt to Judy Webster, PO Box 5043, Algester Qld 4115, Australia