Document Request Form

Please complete the following form and fax it to (212) 722-7650, or mail it to:

The New York Academy of Medicine Library
1216 Fifth Avenue
New York, NY 10029-5293

Contact Information

Name _________________________________________________________

Address _______________________________________________________

City __________________State _______________ Zip Code ____________

Telephone _______________________ Fax__________________________

Payment Information

Credit Card # ________________________Exp ______Sec Code_________

Name on Card __________________________________________________

Delivery Schedule and Fees

Delivery   Turn Around   Charge
Fax/Email   Same Day*   $50/article
Fax/Email   Next day or any other day   $40/article
U.S. Mail   3-5 business days   $30/article

(*Not guaranteed)

Copyright fees, as assigned by the Copyright Clearance Center, are charged in addition to NYAM fees

Delivery Information

Please check off your preferred method of delivery.

[ ] Fax/Email Please provide fax/email for delivery. ____________________

[ ] FedEx Your Acct. # _________________

[ ] Mail

Shipping Address (if different from above)

Name __________________________________________________________

Address ________________________________________________________

City __________________State _______________ Zip Code _____________

ATTN: _________________________________________________________

 

Items

You may only request up to ten (10) items per order from the Academy Library. You may only have one(1) order in process at a time.

Item 1

Author _________________________________________
Book/Journal Title ________________________________
Date _______
Volume # _______ Issue # ______ Pages _____________

Item 2

Author _________________________________________
Book/Journal Title ________________________________
Date _______
Volume # _______ Issue # ______ Pages _____________

Item 3

Author _________________________________________
Book/Journal Title ________________________________
Date _______
Volume # _______ Issue # ______ Pages _____________

Item 4

Author _________________________________________
Book/Journal Title ________________________________
Date _______
Volume # _______ Issue # ______ Pages _____________

Item 5

Author _________________________________________
Book/Journal Title ________________________________
Date _______
Volume # _______ Issue # ______ Pages _____________

Item 6

Author _________________________________________
Book/Journal Title ________________________________
Date _______
Volume # _______ Issue # ______ Pages _____________

Item 7

Author _________________________________________
Book/Journal Title ________________________________
Date _______
Volume # _______ Issue # ______ Pages _____________

Item 8

Author _________________________________________
Book/Journal Title ________________________________
Date _______
Volume # _______ Issue # ______ Pages _____________

Item 9

Author _________________________________________
Book/Journal Title ________________________________
Date _______
Volume # _______ Issue # ______ Pages _____________

Item 10

Author _________________________________________
Book/Journal Title ________________________________
Date _______
Volume # _______ Issue # ______ Pages _____________

Announcement

Library Patrons

Due to a planned renovation project, the Coller Rare Book Reading Room will be closed to readers from February 1, 2013.  We anticipate that the room will reopen for use on June 1 2013. 

Please contact history@nyam.org or 212-822-7313  with queries. We will do our best to accommodate readers and reference requests, but please note that some parts of the collection will not be accessible, response times will be slower and appointment times may be limited. 

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