Media Library Printed Request Form

Archdiocese of Portland in Oregon Resource Center

Please provide the following information, print,  and return to the:
Archdiocese of Portland in Oregon
Resource Center
2838 E Burnside St.
Portland, OR 97214-1895
503.233.8371

 

(*optional)

 
Your Name:
eMail: *

Please provide the following ordering information:

ACCOUNT INFORMATION
Purchase Order *
Account Number *

 
SHIPPING  INFORMATION

ATTN:
First Name Middle Initial Last Name

Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country


 

BILLING INFORMATION (if different from shipping info)

ATTN:

First Name

 Middle Initial Last Name

Organization Work Phone
Street Address FAX
Address (cont.) E-mail
City
State/Province
Zip/Postal Code
Country

 

Order Information

I would like to request the following items:
QTY TITLE CATALOG NUMBER
   

SubTotal

   

Shipping

   

Grand Total


For the following dates:
Click Here to Pick up the timestamp Calendar Utility (for planning only, please enter the dates below)
 
Start Date (the date you want to receive the materials):
-- mm/dd/yy

End Date (the date you want to return the materials):

-- mm/dd/yy

Allow 4 days for delivery.

 


Rental Rates:
$13.00 per film
$5.00 per video, DVD, or conference tape
$3.00 per compact disk
$1.00 per audio cassette, filmstrip, or slide kit

 

Rental Period:
Two weeks, renewals available. Call 503.233.8371 for more information and renewals.

 

Shipping:

Included.  However, you are responsible for any return shipping costs.
Shipping applies only to organizations located outside the Portland metropolitan area. For organizations located in the Portland area, materials must be picked up.

 

 
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