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Gale Web Access Authorization Form

This form is for use by Kansas Libraries

After submitting this form, libraries can expect to receive their own InfoTrac URL (web address) within 7 to 10 days. Instructions will be emailed to the recipient's email address(es) that you provide in the form below; instructions for  using the InfoTrac URL will be included. If you have questions about completing this form, please contact: TGG Contact

Library/Institution Information

Library:
Institution:
Address:
City, State  Zip
Library Contact:
Phone:
Fax:
Library contact Email:
Technical Contact:
Phone:
Fax:
Tech Email:

Internet Access Information

How do you connect to the internet? If you use modems, or share a network with a non-subscribing agency, indicate in (a) below. If you have exclusive use of a private network that connects to the Internet via a firewall or proxy, indicate on (b) the public IP address of your firewall or proxy. Otherwise, indicate (c) the IP address (or range) corresponding to hosts on your IP network.

(a) Dialup IP Provider
(b) Private Network to Internet Gateway (list gateway IP)
(c) Direct Connection to Internet (list all IPs or IP range(s))

Comments / Special Instructions

the form or to clear the form and start again

|     Last modified: Mar 08, 2012