University of Illinois Library Acquisitions: Received Direct Claim Form

RECEIVED DIRECT CLAIM FORM

DATE: _______________________

VENDOR: ____________________

SHIPPING ADDRESS:

_______________________________
_______________________________
_______________________________
_______________________________
_______________________________

BILLING ADDRESS:

University of Illinois Library
Acquisitions Dept., Room 12
1408 W. Gregory Drive
Urbana, IL 61801
USA

***Claim for Serials***

We have not received the following issue(s) of the publication listed below. Please send to our shipping address above as soon as possible.

TITLE ______________________________________________________

VOL., NUMBER, DATE ________________________________________

PURCHASE ORDER NUMBER __________________________________

________________________________________________________________
Vendor response:

GEN.-84