Request #____________
Genealogical Research Request Form – Part 1
Your
Name:___________________________________________________________________________
Mailing
Address:_______________________________________________________________________
City______________________________________
State:___________ Zip Code:___________________
Phone:______________________________ E-mail:_________________________________________
Research fees
$30 for the first hour and $25 per hour for additional
research.
¬
First hour of research @ $30
$________
¬
Subsequent hours of research:
# of hours of research _________ @ $25/hour =
$_______________
Sustaining
or higher level of membership may request 1 complimentary hour per year and $25
per hour for subsequent hours of research.
Complimentary
hour used (date) _______________
*Please note:
¯ A minimum payment equal to one hour of
research must accompany the request, with the exception of the one
complimentary hour per year for Sustaining and higher levels of membership. See
Research by Mail for complete instructions for submitting a request for
research. Please use the secure electronic payment form when submitting a
request by e-mail. (refer to number 8. )
Method of Payment
q Check amount $_____________________ Check
#________________________________________
q Visa
#_____________________________________________ exp. date_______________________
q MasterCard
#_________________________________________ exp. date______________________
Signature
(credit card)___________________________________________________________________
Researchers: The WCHS will invoice you
for additional hours of research only if
you authorize us to do so. Please
check the box and indicate your budget.
q I,________________________________________,
authorize the WCHS to invoice me or bill my credit card if additional hours of research and/or exact citations from the courthouse,
and photocopies if information exceeding the amount paid is needed to
complete the work. Please bill me
for no more than $_______________.
The WCHS will notify those paying by credit card of the total of the
additional research fee by e-mail prior to billing your credit card company.
-------------------------------------------------------------------------------------------------------------------------------
Office use:
Date
processed ______________ Hours requested _____________ Budget ______________ Date Completed _____________
Request # ____________
Genealogical Research Request Form –
Part 2
Please complete as much of
the relevant information on the form as possible. Use one form per
individual/surname or topic to be researched. The fee is structured on a per
request basis, not a cumulative total of research for the year. Each request is assigned an
identification number.
Your
Name:___________________________________________________________________________
Name
to be researched:__________________________________________________________________
Alternate spelling(s) of surname:__________________________________________________________
Birth
date and/or death date:______________________________________________________________
Town
or Township where they lived/died:___________________________________________________
Approximate
span of years that they lived in the county:________________________________________
(Example: They lived in Westmoreland from 1802 to
1845.)
Name
of Spouse(s) & relevant dates:_______________________________________________________
Names
of children & relevant dates:________________________________________________________
_____________________________________________________________________________________
Religious affiliation:______________________________________________________________
Identify
resources consulted thus far:_______________________________________________________
_____________________________________________________________________________________
What information do you hope to discover? You may attach additional sheets if necessary, but please be concise.
-------------------------------------------------------------------------------------------------------------------------------
Office use:
Date
processed ___________ Request #_____________ Hours requested ________ Budget
_________ Date Completed _______