Personal Information
* First name:

* Surname:

Address
Street:

Suburb:

Post Code:

* Country:

* Your e-mail address:

Telephone number:

Fax number:

Addition Information:

Please indicate where you heard about us:
I don't remember
Used you before
Search Engine
Word of mouth
Other
If other, please explain:

Service Identifier
Please indicate the required type of service:
Edit Story (I have written a story on our heritage site/historic place, and require editing/proofreading)

Write Story (I require a story to be written based on our heritage site/historic place.)

Please indicate the name of the heritage site or the suburb/town:

Location Identifier
Please tick if quote is based on a heritage site (usually a building used as a residence).

A homestead may have had several families living in it at various times. How many families are known to have lived there? .

Was the building used to house many people, such as a prison?
Yes
No

Please tick if quote is based on a historic place (usually an isolated area not restricted to a building).

Is the isolated area a large suburb, a small town, or something entirely different? Please specify:

Research Requirement Information
Please indicate the level of research you wish us to carry out on your behalf:

Research Complete (no additional research required)

Research Incomplete (please follow up on additional leads that I may not have discovered already)

Research Required (I have done little to no research and require the entire research to be carried out.

Additional comments:

Final Presentation Information
Please indicate how you would like your finished product to be presented:

A5 bound book/booklet on 150 gsm gloss paper, and delivered via Australia Post. (Please indicate how many copies:

Word document delivered via e-mail.

CD-ROM in web page format delivered via Australia Post. (Please indicate how many copies:

Images
Please indicate if you wish to include any of the following:

Photos that I have collected and will supply
Photos that you have found during research
Certificates that I have collected and will supply
Certificates that you have found during research
Other images that I have collected and will supply

Additional comments: