Free OMB Control No - Federal

OMB Control No. 3095-0046 Expires 06-30-2010

MICROFILM ORDER
Microfilm publication numbers (preceded by and "M" or "T") are assigned to each microfilm publication. Please enter the microfilm publication number and roll number(s) in the proper columns. Because we accept orders for individual rolls, as well as for complete microfilm publications, we must know which rolls you wish to purchase. Effective March 1, 2009, the price for each roll of microfilm is $85 for U.S. orders, $95 for foreign orders. Digitized Microfilm Now Available! The price for each roll of digitized (300 dpi) microfilm on DVD is $125 for U.S. orders, $135 for foreign orders. Shipping is included. These prices are subject to change without notice. For current price information, call 1-866272-6272 (in the Washington, DC area, call 301-837-2000) or visit www.archives.gov.
Sample of correctly completed form.

MICRO. PUB. ROLL NUMBER NUMBER(S)

PRICE

T624 T1270

1138 88­89

$85 $170

Additional order forms are available upon request.

Name Organization (if applicable) ORDERED BY (Include organization if shipping to a business address) Address (number and street) City, State & ZIP Code Daytime Telephone Number (required) Alternate Telephone Number (preferred)

PAYMEN T TYP E

SEND YOUR ORDER/PAYMENT TO:

Check one and enter card number below: CREDIT CARD Signature

VISA

Master Card

American Express

Discover Exp. Date

National Archives Trust Fund Cashier (NAT) Form 72 Order 8601 Adelphi Road College Park, MD 20740-6001 -orIf paying by credit card, you may fax your completed form to 202-357-5906.

OTHER

Check

Money Order

Make payable to: National Archives Trust Fund

A moun t Enclosed: $

IDENTIFY THE ROLLS YOU WISH TO ORDER
MICRO. PUB. NUMBER ROLL NUMBER(S) PRICE
($85/95 Microfilm; $125/135 DVD)

MICRO. PUB. NUMBER

ROLL NUMBER(S)

PRICE
($85/95 Microfilm; $125/135 DVD)

Subtotal (this column) Subtotal (from 1st column) Subtotal (this column) TOTAL PRICE

Your completed order is available either as microfilm or digitally (300 dpi) on DVD; orders may NOT be split between microfilm and DVD. Check one box below for selection: Microfilm ($85/$95 per roll) DVD ($125/$135 per roll) (if no selection is made, microfilm will be generated)

NATIONAL ARCHIVES TRUST FUND BOARD NATF Form 36 (rev. 2-2009)

Privacy Act and Paperwork Reduction Act Public Burden statements are on the reverse of this page.

PRIVACY ACT STATEMENT Collection of this information is authorized by 44 U.S .C. 2108. Disclosure of the information is voluntary; however, we will be unable to respond to your request if you do not furnish your name and address and the minimum required information about the records. The information is used by NARA employees to search for the record; to respond to you; to maintain control over information requests received and answered; and to facilitate preparation of internal statistical reports. If you provide credit card information, that information is used to bill you for copies. PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT A Federal agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number. The OMB Control No. for this information collection is 30950046. Public burden reporting for this collection of information is estimated to be 10 minutes per response. Send comments regarding the burden estimate or any other aspect of the information collection, including suggestions for reducing this burden, to National Archives and Records Administration (NHP), 8601 Adelphi Road, College Park MD 20740. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. SEND COMPLETED FORMS TO THE ADDRESS INDICATED ON THE FORM ITSELF.
NATIONAL ARCHIVES TRUST FUND BOARD NATF Form 36 (rev. 2-2009)