Online Research Request Form

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Mobile Phone

(###)

###

####

Email

Confirm Email

Brief summary of your request

SEARCH FEES

Within Australia and Overseas ..........$35 for first 2 hours ($10 per hour thereafter)

HOW TO PAY

Direct deposit into the following account:

BSB: 633 000

Account No.: 117 168 088

OR by cheque made payable to Romsey & Lancefield Districts Historical Society.

Note: Please identify the deposit with ‘RESEARCH FEE’ and your name.